Provider Demographics
NPI:1831605278
Name:ROSEN, DAVID (PA-C)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:ROSEN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13145 CHARLESTON HWY
Mailing Address - Street 2:
Mailing Address - City:ROUND O
Mailing Address - State:SC
Mailing Address - Zip Code:29474-3691
Mailing Address - Country:US
Mailing Address - Phone:843-290-1286
Mailing Address - Fax:
Practice Address - Street 1:120 MEDICAL PARK DR
Practice Address - Street 2:
Practice Address - City:WALTERBORO
Practice Address - State:SC
Practice Address - Zip Code:29488-5719
Practice Address - Country:US
Practice Address - Phone:843-782-4141
Practice Address - Fax:843-549-7967
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-21
Last Update Date:2019-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2906207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty