Provider Demographics
NPI:1750360178
Name:RUPP, NED T (MD)
Entity type:Individual
Prefix:DR
First Name:NED
Middle Name:T
Last Name:RUPP
Suffix:
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 1:7555 NORTHSIDE DR
Mailing Address - Street 2:
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29420-4211
Mailing Address - Country:US
Mailing Address - Phone:843-797-8162
Mailing Address - Fax:843-820-1300
Practice Address - Street 1:7555 NORTHSIDE DR
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29420-4211
Practice Address - Country:US
Practice Address - Phone:843-797-8162
Practice Address - Fax:843-820-1300
Is Sole Proprietor?:No
Enumeration Date:2006-01-13
Last Update Date:2015-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC19514207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCG31821Medicaid
SCE78667Medicare UPIN
SCE786676309Medicare PIN
SCE786676081Medicare PIN
SCG31821Medicaid