Individual
DR. GARY A DEROSA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
A. T. AUGUSTA MILITARY MEDICAL CENTER, 9300 DEWITT LOOP, FT. BELVOIR, VA 22060
(571) 231-4012
Mailing address
12735 GOLD CUP TRL, MANASSAS, VA 20112-3684
(703) 599-1274
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
0101032730
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1770583205
—
VA
05
—
5617537
—
VA
Enumeration date
07/27/2005
Last updated
08/27/2024
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