Provider Demographics
NPI:1588603500
Name:ROSENBAUM, PETER JON (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:JON
Last Name:ROSENBAUM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1012 COLLETON WAY
Mailing Address - Street 2:
Mailing Address - City:TRENT WOODS
Mailing Address - State:NC
Mailing Address - Zip Code:28562-7257
Mailing Address - Country:US
Mailing Address - Phone:252-636-1936
Mailing Address - Fax:
Practice Address - Street 1:2719 NEUSE BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28562-2840
Practice Address - Country:US
Practice Address - Phone:252-633-6117
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89137HHMedicaid
NC2026741Medicare ID - Type Unspecified
NC89137HHMedicaid