Healthcare Provider Details

I. General information

NPI: 1285325761
Provider Name (Legal Business Name): MARY KAITLYN ROSIEK DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2023
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 MAIN ST W STE A
OAK HILL WV
25901-2972
US

IV. Provider business mailing address

119 MAIN ST W STE A
OAK HILL WV
25901-2972
US

V. Phone/Fax

Practice location:
  • Phone: 304-465-0544
  • Fax:
Mailing address:
  • Phone: 304-465-0544
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5055
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: