Provider Demographics
NPI:1487755906
Name:PETER ROSANELLI JR LTD
Entity type:Organization
Organization Name:PETER ROSANELLI JR LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:WILLIAMS
Authorized Official - Last Name:BISSET
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-285-7369
Mailing Address - Street 1:5855 BRENO RD
Mailing Address - Street 2:SUITE 305
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23226
Mailing Address - Country:US
Mailing Address - Phone:804-285-7369
Mailing Address - Fax:804-285-7360
Practice Address - Street 1:5855 BRENO RD
Practice Address - Street 2:SUITE 305
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23226
Practice Address - Country:US
Practice Address - Phone:804-285-7369
Practice Address - Fax:804-285-7360
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101017479207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA076457OtherANTHEM
VA548761OtherAETNA
VA548761OtherAETNA