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General NPI Number Information
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NPI Number | 1801907936
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Entity Type | Individual
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Provider Name | MARIANNE WAY ROSEN M.D.
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Gender | Female
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 10/26/2011
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Provider Practice Location Address
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Address Line | 776 DANIEL ELLIS DR UNIT 1 A
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City | CHARLESTON
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State | SC
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Zip | 29412-3094
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Country | US
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Telephone | 843-723-6529
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Fax | 843-723-0424
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Provider Business Mailing Address
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Address Line | 776 DANIEL ELLIS DR UNIT 1 A
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City | CHARLESTON
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State | SC
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Zip | 29412-3094
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Country | US
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Telephone | 843-723-6529
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Fax | 843-723-0424
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 12888
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License Number State | SC
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