MEDICARE: ROBERT ROUNSEVILLE

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	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1760730816
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT ROUNSEVILLE

Provider Business Mailing Address
First Line	:	98 N FRONT ST
Second Line	:	3RD FL
City	:	NEW BEDFORD
State	:	MA
Zip	:	02740-7327
Country	:	US
Telephone Number	:	508-997-0475
Fax Number	:	508-997-0765

Provider Business Practice Location Address
First Line	:	98 N FRONT ST
Second Line	:	3RD FL
City	:	NEW BEDFORD
State	:	MA
Zip	:	02740-7327
Country	:	US
Telephone Number	:	508-997-0475
Fax Number	:	508-997-0765

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

Provider Enumeration Date	:	08/21/2012
Last Update Date	:	08/21/2012

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