Provider Demographics
NPI:1588614176
Name:MUNSEE, ROCK ALLEN (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:MR
First Name:ROCK
Middle Name:ALLEN
Last Name:MUNSEE
Suffix:
Gender:M
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6035 FAIRVIEW RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-3256
Mailing Address - Country:US
Mailing Address - Phone:704-295-3000
Mailing Address - Fax:
Practice Address - Street 1:200 S HERLONG AVE
Practice Address - Street 2:SUITE A
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-3399
Practice Address - Country:US
Practice Address - Phone:803-328-1864
Practice Address - Fax:803-328-1865
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2015-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-01599363A00000X
SC1386363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC0953PAMedicaid
NC1951786OtherCOVENTRY
NCP01044561OtherRAILROAD MEDICARE PTAN
SC20083727OtherSELECT HEALTH OF SC
NC8102538Medicaid
SCP01084938OtherMEDICARE RAILROAD
NC164XCOtherBCBSNC
SC20083727OtherSELECT HEALTH OF SC
SC0953PAMedicaid