Healthcare Provider Details

I. General information

NPI: 1972698876
Provider Name (Legal Business Name): ROSEMAR MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 ROSEMAR CIR
PARKERSBURG WV
26104-1204
US

IV. Provider business mailing address

4 ROSEMAR CIR
PARKERSBURG WV
26104-1204
US

V. Phone/Fax

Practice location:
  • Phone: 304-485-6130
  • Fax: 304-485-1519
Mailing address:
  • Phone: 304-485-6130
  • Fax: 304-485-1519

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number008419
License Number StateWV

VIII. Authorized Official

Name: DR. JOHN E. BEANE
Title or Position: PRESIDENT
Credential: M.D.
Phone: 304-485-6130