Provider Demographics
NPI:1982791414
Name:RADER, ROSE (PA)
Entity Type:Individual
Prefix:
First Name:ROSE
Middle Name:
Last Name:RADER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:ANN-MARIE
Other - Middle Name:
Other - Last Name:RADER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 280
Mailing Address - Street 2:
Mailing Address - City:SAINT STEPHEN
Mailing Address - State:SC
Mailing Address - Zip Code:29479-0280
Mailing Address - Country:US
Mailing Address - Phone:843-567-4000
Mailing Address - Fax:843-567-3000
Practice Address - Street 1:137 CEDAR ST
Practice Address - Street 2:
Practice Address - City:SAINT STEPHEN
Practice Address - State:SC
Practice Address - Zip Code:29479-3371
Practice Address - Country:US
Practice Address - Phone:843-567-4000
Practice Address - Fax:843-567-3000
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2007-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1147363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC0458PAMedicaid
SC0458PAMedicaid
SCAA15548479Medicare PIN