MEDICARE: DR. PETER JON ROSENBAUM M.D.

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	207L00000X	Anesthesiology Physician		NC

Other Identifiers

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

General Provider Information

NPI Number	:	1588603500
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PETER JON ROSENBAUM M.D.

Provider Business Mailing Address
First Line	:	1012 COLLETON WAY
Second Line	:
City	:	TRENT WOODS
State	:	NC
Zip	:	28562-7257
Country	:	US
Telephone Number	:	252-636-1936
Fax Number	:

Provider Business Practice Location Address
First Line	:	2719 NEUSE BLVD
Second Line	:	SUITE B
City	:	NEW BERN
State	:	NC
Zip	:	28562-2840
Country	:	US
Telephone Number	:	252-633-6117
Fax Number	:

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

Provider Enumeration Date	:	06/05/2006
Last Update Date	:	07/08/2007

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