Healthcare Provider Details

I. General information

NPI: 1063729309
Provider Name (Legal Business Name): MARIANNE W ROSEN,M.D & ASSOCIATESLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2010
Last Update Date: 01/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

776 DANIEL ELLIS DR UNIT 1 A
CHARLESTON SC
29412-3094
US

IV. Provider business mailing address

776 DANIEL ELLIS DR UNIT 1 A
CHARLESTON SC
29412-3094
US

V. Phone/Fax

Practice location:
  • Phone: 843-723-6529
  • Fax:
Mailing address:
  • Phone: 843-723-6529
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MARIANNE W ROSEN
Title or Position: OWNER
Credential: M.D.
Phone: 843-723-6529