MEDICARE: ROBERT F. NEMEROFF, M.D., INC.

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	2082S0099X	Plastic Surgery Within the Head and Neck (Plastic Surgery) Physician	G66348	CA
2	207YS0123X	Facial Plastic Surgery Physician	G66348	CA

General Provider Information

NPI Number	:	1407924137
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROBERT F. NEMEROFF, M.D., INC.

Provider Business Mailing Address
First Line	:	9663 SANTA MONICA BLVD
Second Line	:	#556
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90210-4303
Country	:	US
Telephone Number	:	310-441-0051
Fax Number	:	310-441-0052

Provider Business Practice Location Address
First Line	:	1509 MANNING AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90024-5813
Country	:	US
Telephone Number	:	310-441-0051
Fax Number	:	310-441-0052

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ROBERT F. NEMEROFF
Credential	:	M.D.
Telephone Number	:	310-441-0051

Provider Enumeration Date	:	12/01/2006
Last Update Date	:	08/22/2008

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