# PETER ROSANELLI JR LTD

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1487755906
- **Authorized official:** MRS. ELIZABETH WILLIAMS BISSET (OFFICE MANAGER)
- **Authorized official phone:** (804) 285-7369

## Contact information

- **Practice address:** 5855 BRENO RD, SUITE 305, RICHMOND, VA 23226
- **Practice address phone:** (804) 285-7369
- **Practice address fax:** (804) 285-7360
- **Mailing address:** 5855 BRENO RD, SUITE 305, RICHMOND, VA 23226
- **Mailing address phone:** (804) 285-7369
- **Mailing address fax:** (804) 285-7360

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207V00000X | Obstetrics & Gynecology Physician | 0101017479 | VA | Yes |

## Other

- **Enumeration date:** 09/26/2006
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 076457 | ANTHEM | VA |
| 01 | — | 548761 | AETNA | VA |