Healthcare Provider Details

I. General information

NPI: 1699207944
Provider Name (Legal Business Name): RUPA KOOTHIREZHI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2017
Last Update Date: 07/07/2025
Certification Date: 07/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 HAROLD FLEMING CT
SPARTANBURG SC
29303-4225
US

IV. Provider business mailing address

151 HAROLD FLEMING CT
SPARTANBURG SC
29303-4225
US

V. Phone/Fax

Practice location:
  • Phone: 864-573-6320
  • Fax:
Mailing address:
  • Phone: 864-573-6320
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number323519
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code207QS1201X
TaxonomySleep Medicine (Family Medicine) Physician
License Number323519
License Number StateLA
# 3
Primary TaxonomyY
Taxonomy Code207QS1201X
TaxonomySleep Medicine (Family Medicine) Physician
License Number94690
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: