Provider Demographics
NPI:1093786477
Name:UPSTATE ENT ASSOCIATES, P.A.
Entity Type:Organization
Organization Name:UPSTATE ENT ASSOCIATES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:G
Authorized Official - Last Name:RAO
Authorized Official - Suffix:
Authorized Official - Credentials:MD, FACS
Authorized Official - Phone:864-886-9669
Mailing Address - Street 1:414 OLD CLEMSON HWY
Mailing Address - Street 2:
Mailing Address - City:SENECA
Mailing Address - State:SC
Mailing Address - Zip Code:29672-7533
Mailing Address - Country:US
Mailing Address - Phone:864-886-9669
Mailing Address - Fax:864-886-9671
Practice Address - Street 1:414 OLD CLEMSON HWY
Practice Address - Street 2:
Practice Address - City:SENECA
Practice Address - State:SC
Practice Address - Zip Code:29672-7533
Practice Address - Country:US
Practice Address - Phone:864-886-9669
Practice Address - Fax:864-886-9671
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-01
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC4284Medicare PIN