Provider Demographics
NPI:1063729309
Name:MARIANNE W ROSEN,M.D & ASSOCIATESLLC
Entity type:Organization
Organization Name:MARIANNE W ROSEN,M.D & ASSOCIATESLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIANNE
Authorized Official - Middle Name:W
Authorized Official - Last Name:ROSEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:843-723-6529
Mailing Address - Street 1:776 DANIEL ELLIS DR
Mailing Address - Street 2:UNIT 1 A
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29412-3094
Mailing Address - Country:US
Mailing Address - Phone:843-723-6529
Mailing Address - Fax:
Practice Address - Street 1:776 DANIEL ELLIS DR
Practice Address - Street 2:UNIT 1 A
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29412-3094
Practice Address - Country:US
Practice Address - Phone:843-723-6529
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-08
Last Update Date:2012-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Single Specialty
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCDR6551OtherRAIL ROAD MEDICARE
SCDR6551OtherRAIL ROAD MEDICARE