Provider Demographics
NPI:1083687156
Name:ALTEMUS, ROSEMARY M (MD)
Entity Type:Individual
Prefix:
First Name:ROSEMARY
Middle Name:M
Last Name:ALTEMUS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 31436
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23294-1436
Mailing Address - Country:US
Mailing Address - Phone:804-266-8717
Mailing Address - Fax:804-266-5677
Practice Address - Street 1:1850 TOWN CENTER PARKWAY
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190
Practice Address - Country:US
Practice Address - Phone:703-689-9330
Practice Address - Fax:703-689-9334
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01012344262085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
466264OtherANTHEM BCBS
50730002OtherCAREFIRST
VA010020352Medicaid
6396775001OtherCIGNA
2114467OtherMAMSI
3288786OtherAETNA
4336556OtherAETNA
VA010020352Medicaid
P00051362Medicare ID - Type UnspecifiedRAILROAD
VA00B936M67Medicare PIN