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General NPI Number Information
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NPI Number | 1356435747
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Entity Type | Individual
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Provider Name | PETER ROSANDICH M.D.
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Gender | Male
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Dates
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Enumeration Date | 10/03/2006
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Last Update Date | 12/02/2010
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Provider Practice Location Address
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Address Line | 8200 LOUISIANA BLVD NE NEW MEXICO RHEUMATOLOGY LLC
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City | ALBUQUERQUE
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State | NM
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Zip | 87113-2105
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Country | US
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Telephone | 505-828-2400
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Fax | 505-828-2401
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Provider Business Mailing Address
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Address Line | PO BOX 93008 NEW MEXICO RHEUMATOLOGY LLC
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City | ALBUQUERQUE
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State | NM
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Zip | 87199-3008
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Country | US
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Telephone | 505-828-2400
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Fax | 505-828-2401
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RR0500X
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Taxonomy Name | Rheumatology Physician
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License Number | MD2005-0123
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License Number State | NM
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