Provider Demographics
NPI:1598965113
Name:RACHEL ROCKMAN PETERSEN, MD PC
Entity Type:Organization
Organization Name:RACHEL ROCKMAN PETERSEN, MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:ROCKMAN
Authorized Official - Last Name:PETERSEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:256-882-1785
Mailing Address - Street 1:PO BOX 12476
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35815-2476
Mailing Address - Country:US
Mailing Address - Phone:256-882-1785
Mailing Address - Fax:256-882-1770
Practice Address - Street 1:4810 WHITESPORT CIR SW
Practice Address - Street 2:SUITE 100
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-7419
Practice Address - Country:US
Practice Address - Phone:256-882-1785
Practice Address - Fax:256-882-1770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-21
Last Update Date:2007-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL28071207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51005688OtherBLUE CROSS/BLUE SHIELD