Healthcare Provider Details

I. General information

NPI: 1124087101
Provider Name (Legal Business Name): DANIEL L ROSNER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

915 MEDICAL CIRCLE
MYRTLE BEACH SC
29572
US

IV. Provider business mailing address

915 MEDICAL CIRCLE
MYRTLE BEACH SC
29572
US

V. Phone/Fax

Practice location:
  • Phone: 843-449-6449
  • Fax: 843-449-1069
Mailing address:
  • Phone: 843-449-6449
  • Fax: 843-449-1069

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0007X
TaxonomyPlastic Surgery within the Head & Neck (Otolaryngology) Physician
License Number15659
License Number StateSC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier156592
Identifier TypeMEDICAID
Identifier StateSC
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: