Provider Demographics
NPI:1780791806
Name:ROSENBERG, PETER JOSIAH (MD)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:JOSIAH
Last Name:ROSENBERG
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 1:74 SECOND ST
Mailing Address - Street 2:#2
Mailing Address - City:HALLOWELL
Mailing Address - State:ME
Mailing Address - Zip Code:04347-1487
Mailing Address - Country:US
Mailing Address - Phone:207-623-2827
Mailing Address - Fax:
Practice Address - Street 1:1 VA CENTER AT TOGUS
Practice Address - Street 2:112C
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04330
Practice Address - Country:US
Practice Address - Phone:207-623-8411
Practice Address - Fax:207-621-4853
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTA15522174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist