Provider Demographics
NPI:1659494482
Name:GRIBOVSKAJA-RUPP, IRENA (MD)
Entity type:Individual
Prefix:
First Name:IRENA
Middle Name:
Last Name:GRIBOVSKAJA-RUPP
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:IRENA
Other - Middle Name:
Other - Last Name:GRIBOVSKAJA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:300 E MCBEE AVE FL 4
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29601-2842
Mailing Address - Country:US
Mailing Address - Phone:864-695-6697
Mailing Address - Fax:
Practice Address - Street 1:1333 TAYLOR ST STE 5F
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-2951
Practice Address - Country:US
Practice Address - Phone:803-748-9966
Practice Address - Fax:803-749-7174
Is Sole Proprietor?:No
Enumeration Date:2007-04-08
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAMD-42736208600000X, 208C00000X
SC92626208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery