Provider Demographics
NPI:1134148281
Name:ROSEBROCK, GEORGE L JR (MD)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:L
Last Name:ROSEBROCK
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 751649
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1649
Mailing Address - Country:US
Mailing Address - Phone:843-789-1620
Mailing Address - Fax:843-724-2440
Practice Address - Street 1:3531 MARY ADER DRIVE
Practice Address - Street 2:BLDG A
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29414
Practice Address - Country:US
Practice Address - Phone:843-744-1669
Practice Address - Fax:843-769-9971
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2015-10-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
SC06121207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC061211Medicaid
SCP00648639OtherRAILROAD MEDICARE
SCP00727214OtherRAILROAD MEDICARE ID-RSFPP
SCD992445551Medicare PIN
SCD992449223Medicare PIN