Provider Demographics
NPI:1942610472
Name:TILLER, ROSANNE (MD)
Entity Type:Individual
Prefix:
First Name:ROSANNE
Middle Name:
Last Name:TILLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ROSANNE
Other - Middle Name:
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6011 FARRINGTON RD UNIT 101
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27517-8168
Mailing Address - Country:US
Mailing Address - Phone:919-843-4096
Mailing Address - Fax:919-966-9746
Practice Address - Street 1:6011 FARRINGTON RD UNIT 101
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27517
Practice Address - Country:US
Practice Address - Phone:919-843-4096
Practice Address - Fax:919-966-9746
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-06
Last Update Date:2020-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC201624390200000X
NC2016-02029207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty