Healthcare Provider Details

I. General information

NPI: 1356435747
Provider Name (Legal Business Name): PETER ROSANDICH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 12/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8200 LOUISIANA BLVD NE NEW MEXICO RHEUMATOLOGY LLC
ALBUQUERQUE NM
87113-2105
US

IV. Provider business mailing address

PO BOX 93008 NEW MEXICO RHEUMATOLOGY LLC
ALBUQUERQUE NM
87199-3008
US

V. Phone/Fax

Practice location:
  • Phone: 505-828-2400
  • Fax: 505-828-2401
Mailing address:
  • Phone: 505-828-2400
  • Fax: 505-828-2401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberMD2005-0123
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: