Provider Demographics
NPI:1225101488
Name:MARIANNE W ROSEN, M.D.
Entity Type:Organization
Organization Name:MARIANNE W ROSEN, M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIANOWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIANNE
Authorized Official - Middle Name:WAY
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:843-723-0424
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:843-723-0424
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2010-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC4195Medicare ID - Type Unspecified