Healthcare Provider Details

I. General information

NPI: 1821045139
Provider Name (Legal Business Name): PETER A ROSARIO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2006
Last Update Date: 10/31/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 SAINT MARYS DR SUITE 200
EVANSVILLE IN
47714-0520
US

IV. Provider business mailing address

901 SAINT MARYS DR SUITE 200
EVANSVILLE IN
47714-0520
US

V. Phone/Fax

Practice location:
  • Phone: 812-485-6030
  • Fax: 812-485-6032
Mailing address:
  • Phone: 812-485-6030
  • Fax: 812-485-6032

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number01038767
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number01038767A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: