Provider Demographics
NPI:1194350470
Name:HALDEMAN, ROSALYN MARIE (PA)
Entity type:Individual
Prefix:
First Name:ROSALYN
Middle Name:MARIE
Last Name:HALDEMAN
Suffix:
Gender:
Credentials:PA
Other - Prefix:
Other - First Name:ROSALYN
Other - Middle Name:MARIE
Other - Last Name:RUNDE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:PO BOX 751649
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1649
Mailing Address - Country:US
Mailing Address - Phone:888-472-0043
Mailing Address - Fax:843-724-2440
Practice Address - Street 1:325 FOLLY RD STE 102A
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29412-2507
Practice Address - Country:US
Practice Address - Phone:843-762-1440
Practice Address - Fax:843-762-6979
Is Sole Proprietor?:No
Enumeration Date:2020-03-07
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3944363A00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC4976PAMedicaid