Provider Demographics
NPI:1598794364
Name:RAPP, EDWARD JOSEPH II (MD)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:JOSEPH
Last Name:RAPP
Suffix:II
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 INDEPENDENCE PT STE 212
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-4536
Mailing Address - Country:US
Mailing Address - Phone:864-797-6303
Mailing Address - Fax:
Practice Address - Street 1:105 VINECREST CT
Practice Address - Street 2:STE 500
Practice Address - City:GREENWOOD
Practice Address - State:SC
Practice Address - Zip Code:29646-8031
Practice Address - Country:US
Practice Address - Phone:864-227-8932
Practice Address - Fax:864-227-8973
Is Sole Proprietor?:No
Enumeration Date:2006-07-02
Last Update Date:2018-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC17678208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC176785Medicaid
SCF934877951Medicare PIN
SC176785Medicaid
SCF93487Medicare UPIN