Healthcare Provider Details

I. General information

NPI: 1093786477
Provider Name (Legal Business Name): UPSTATE ENT ASSOCIATES, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2006
Last Update Date: 10/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

414 OLD CLEMSON HWY
SENECA SC
29672-7533
US

IV. Provider business mailing address

414 OLD CLEMSON HWY
SENECA SC
29672-7533
US

V. Phone/Fax

Practice location:
  • Phone: 864-886-9669
  • Fax: 864-886-9671
Mailing address:
  • Phone: 864-886-9669
  • Fax: 864-886-9671

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: DR. FRANK G RAO
Title or Position: PRESIDENT
Credential: MD, FACS
Phone: 864-886-9669