Provider Demographics
NPI:1427057454
Name:BRETHAUER, ROBERT CAMERON (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:CAMERON
Last Name:BRETHAUER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ROBERT
Other - Middle Name:CAMERON
Other - Last Name:BRETHAUER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:706 RIVERWAY PL
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03110-6768
Mailing Address - Country:US
Mailing Address - Phone:603-623-3516
Mailing Address - Fax:603-623-3580
Practice Address - Street 1:706 RIVERWAY PL
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:NH
Practice Address - Zip Code:03110-6768
Practice Address - Country:US
Practice Address - Phone:603-623-3516
Practice Address - Fax:603-623-3580
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH6278207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH5962027OtherCIGNA
NH0104675Y0NH01OtherANTHEM
NH81290081Medicaid
NHE70882OtherHARVARD
NH5962027OtherCIGNA
NH81290081Medicaid