Provider Demographics
NPI:1356435747
Name:ROSANDICH, PETER (MD)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:
Last Name:ROSANDICH
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 93008
Mailing Address - Street 2:NEW MEXICO RHEUMATOLOGY LLC
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87199-3008
Mailing Address - Country:US
Mailing Address - Phone:505-828-2400
Mailing Address - Fax:505-828-2401
Practice Address - Street 1:8200 LOUISIANA BLVD NE
Practice Address - Street 2:NEW MEXICO RHEUMATOLOGY LLC
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87113-2105
Practice Address - Country:US
Practice Address - Phone:505-828-2400
Practice Address - Fax:505-828-2401
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2010-12-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NMMD2005-0123207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM78834295Medicaid
348522709Medicare PIN
NM78834295Medicaid