Provider Demographics
NPI:1568497394
Name:ROSENSHEIN, IRA LAWRENCE (MD)
Entity Type:Individual
Prefix:DR
First Name:IRA
Middle Name:LAWRENCE
Last Name:ROSENSHEIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1030 JENKINS RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407-5704
Mailing Address - Country:US
Mailing Address - Phone:843-852-0083
Mailing Address - Fax:843-852-0087
Practice Address - Street 1:1030 JENKINS RD
Practice Address - Street 2:SUITE A
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-5704
Practice Address - Country:US
Practice Address - Phone:843-852-0083
Practice Address - Fax:843-852-0087
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2015-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC185542084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC185542Medicaid
SCF810058956Medicare PIN
SCF81005Medicare UPIN