Healthcare Provider Details

I. General information

NPI: 1639282411
Provider Name (Legal Business Name): REBECCA E ROUSE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 08/08/2024
Certification Date: 08/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

128 ROUTE 27
RAYMOND NH
03077-1230
US

IV. Provider business mailing address

128 ROUTE 27
RAYMOND NH
03077-1220
US

V. Phone/Fax

Practice location:
  • Phone: 603-895-3051
  • Fax:
Mailing address:
  • Phone: 603-895-3051
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number1166688
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number19475
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: