Individual
ANTHONY JOHN DEROSA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
860 OMNI BLVD, SUITE 201, NEWPORT NEWS, VA 23606-4430
(757) 223-5321
(757) 223-7271
Mailing address
860 OMNI BLVD, SUITE 303, NEWPORT NEWS, VA 23606-4430
(757) 232-8769
(757) 232-8875
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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