Individual
ANTHONY JOHN DEROSA
Active
Individual
ANTHONY JOHN DEROSA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
0101056744
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10057
OPTIMA
VI
01
—
180035098
RR MEDICARE
VA
01
—
242760
ANTHEM BC/BS
VI
05
—
6304991
—
VA
01
—
890588L
NC MEDICAID
NC
Enumeration date
06/16/2005
Last updated
07/08/2014
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