Provider Demographics
NPI:1932223658
Name:SHIM, ROSEMARIE LIN (MD)
Entity type:Individual
Prefix:
First Name:ROSEMARIE
Middle Name:LIN
Last Name:SHIM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:985 W 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43212-3109
Mailing Address - Country:US
Mailing Address - Phone:614-291-0022
Mailing Address - Fax:614-291-6687
Practice Address - Street 1:985 W 3RD AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43212-3109
Practice Address - Country:US
Practice Address - Phone:614-291-0022
Practice Address - Fax:614-291-6687
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2016-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35081787207RN0300X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2473238Medicaid
OH2473238Medicaid
OHSH4129881Medicare PIN