Healthcare Provider Details

I. General information

NPI: 1750360178
Provider Name (Legal Business Name): NED T RUPP M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2006
Last Update Date: 11/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7555 NORTHSIDE DR
NORTH CHARLESTON SC
29420-4211
US

IV. Provider business mailing address

7555 NORTHSIDE DR
NORTH CHARLESTON SC
29420-4211
US

V. Phone/Fax

Practice location:
  • Phone: 843-797-8162
  • Fax: 843-820-1300
Mailing address:
  • Phone: 843-797-8162
  • Fax: 843-820-1300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number19514
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: