MEDICARE: DR. ROBYN B NOTTERMAN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207N00000X	Dermatology Physician	25MA05785400	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0267484005	OTHER	NJ	CIGNA
2	2351569000	OTHER	NJ	AMERIHEALTH
3	3722194	OTHER	NJ	AETNA

General Provider Information

NPI Number	:	1124008958
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBYN B NOTTERMAN M.D.

Provider Business Mailing Address
First Line	:	601 EWING ST
Second Line	:	SUITE C-13
City	:	PRINCETON
State	:	NJ
Zip	:	08540-2757
Country	:	US
Telephone Number	:	609-924-1033
Fax Number	:	609-924-7055

Provider Business Practice Location Address
First Line	:	601 EWING ST
Second Line	:	SUITE C-13
City	:	PRINCETON
State	:	NJ
Zip	:	08540-2757
Country	:	US
Telephone Number	:	609-924-1033
Fax Number	:	609-924-7055

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/18/2006
Last Update Date	:	07/08/2007

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