Provider Demographics
NPI:1467565614
Name:ROMULO, RODRIGO LUIS (MD)
Entity Type:Individual
Prefix:
First Name:RODRIGO
Middle Name:LUIS
Last Name:ROMULO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6161 KEMPSVILLE CIR STE 220
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23502-3932
Mailing Address - Country:US
Mailing Address - Phone:757-455-9036
Mailing Address - Fax:757-455-9037
Practice Address - Street 1:713 VOLVO PKWY
Practice Address - Street 2:SUTIE 100
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-1614
Practice Address - Country:US
Practice Address - Phone:757-455-9036
Practice Address - Fax:757-455-9037
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2014-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101235722207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA10116333Medicaid
VA005446V21Medicare ID - Type Unspecified
VAF08063Medicare UPIN
VA005446V21Medicare ID - Type Unspecified
VA541912287OtherAETNA