Healthcare Provider Details

I. General information

NPI: 1811956329
Provider Name (Legal Business Name): PETER ROME BENDETSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2006
Last Update Date: 01/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1180 BEACON STREET, SUITE 3A
BROOKLINE MA
02446-3806
US

IV. Provider business mailing address

1180 BEACON ST STE 3A
BROOKLINE MA
02446-3806
US

V. Phone/Fax

Practice location:
  • Phone: 617-566-3123
  • Fax: 617-739-1231
Mailing address:
  • Phone: 617-566-3123
  • Fax: 617-739-1231

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberME38840
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: