Provider Demographics
NPI:1124740683
Name:ROSEMAN, MANGALISO
Entity type:Individual
Prefix:
First Name:MANGALISO
Middle Name:
Last Name:ROSEMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3909 S CREEK CT
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30083-7005
Mailing Address - Country:US
Mailing Address - Phone:510-467-8485
Mailing Address - Fax:
Practice Address - Street 1:3909 S CREEK CT
Practice Address - Street 2:
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30083-7005
Practice Address - Country:US
Practice Address - Phone:510-467-8485
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-13
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)