Provider Demographics
NPI:1801907936
Name:ROSEN, MARIANNE WAY (MD)
Entity type:Individual
Prefix:
First Name:MARIANNE
Middle Name:WAY
Last Name:ROSEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:776 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
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2011-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC12888207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC4195Medicare ID - Type Unspecified
SCE30818Medicare UPIN