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NPI Code Detail

MEDICARE: ROSE RADER PA

MEDICARE: ROSE RADER PA
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
1363AM0700XMedical Physician Assistant1147SC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1982791414
Entity Type Code : Individual
Provider Name (Legal Business Name) : ROSE RADER PA
Provider Business Mailing Address
First Line : 110 EXECUTIVE PARK WAY
Second Line :
City : MONCKS CORNER
State : SC
Zip : 29461-3930
Country : US
Telephone Number : 843-899-9099
Fax Number : 843-899-9091
Provider Business Practice Location Address
First Line : 110 EXECUTIVE PARK WAY
Second Line :
City : MONCKS CORNER
State : SC
Zip : 29461-3930
Country : US
Telephone Number : 843-899-9099
Fax Number : 843-899-9091
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/06/2006
Last Update Date : 12/03/2024

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Directions to “ ROSE RADER PA” Practice Location

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