Healthcare Provider Details

I. General information

NPI: 1093777393
Provider Name (Legal Business Name): JEFFREY MICHAEL RUGGIERI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2006
Last Update Date: 05/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 GROVE RD
GREENVILLE SC
29605-5611
US

IV. Provider business mailing address

701 GROVE RD NEONATOLOGY DEPT, 6TH FLOOR SUPPORT TOWER
GREENVILLE SC
29605-5611
US

V. Phone/Fax

Practice location:
  • Phone: 864-455-7939
  • Fax: 864-455-3685
Mailing address:
  • Phone: 864-455-7939
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number22502
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: