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General NPI Number Information
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NPI Number | 1659494482
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Entity Type | Individual
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Provider Name | IRENA GRIBOVSKAJA-RUPP M.D.
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Gender | Female
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Dates
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Enumeration Date | 04/08/2007
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Last Update Date | 08/26/2024
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Provider Practice Location Address
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Address Line | 1333 TAYLOR ST STE 5F
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City | COLUMBIA
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State | SC
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Zip | 29201-2951
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Country | US
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Telephone | 803-748-9966
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Fax | 803-749-7174
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Provider Business Mailing Address
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Address Line | 300 E MCBEE AVE FL 4
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City | GREENVILLE
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State | SC
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Zip | 29601-2842
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Country | US
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Telephone | 864-695-6697
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | MD-42736
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License Number State | IA
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Taxonomy #2
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Taxonomy Code | 208C00000X
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Taxonomy Name | Colon & Rectal Surgery Physician
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License Number | MD-42736
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License Number State | IA
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Taxonomy #3
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Taxonomy Code | 208C00000X
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Taxonomy Name | Colon & Rectal Surgery Physician
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License Number | 92626
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License Number State | SC
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