Provider Demographics
NPI:1831908961
Name:ROSIEK, MARCIA
Entity type:Individual
Prefix:
First Name:MARCIA
Middle Name:
Last Name:ROSIEK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:603 HATTERAS RIVER RD
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29588-7463
Mailing Address - Country:US
Mailing Address - Phone:843-582-4458
Mailing Address - Fax:
Practice Address - Street 1:603 HATTERAS RIVER RD
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29588-7463
Practice Address - Country:US
Practice Address - Phone:843-582-4458
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-03
Last Update Date:2025-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCA-3827549171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor