MEDICARE: DR. SAMUEL H ROSEN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0802X	Addiction Psychiatry Physician	10866	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00886821	OTHER	SC	RAILROAD MC ID-RSFPN
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1265430862
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SAMUEL H ROSEN MD

Provider Business Mailing Address
First Line	:	PO BOX 751649
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28275-1649
Country	:	US
Telephone Number	:	843-789-1620
Fax Number	:	843-724-2440

Provider Business Practice Location Address
First Line	:	2097 HENRY TECKLENBURG DR STE 211W
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29414-5739
Country	:	US
Telephone Number	:	843-958-2555
Fax Number	:	843-402-1961

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/08/2005
Last Update Date	:	01/29/2021

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Directions to “ DR. SAMUEL H ROSEN MD” Practice Location

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