Provider Demographics
NPI:1477666733
Name:ROSADO-TORRES, IDALIA VANESSA (MD)
Entity Type:Individual
Prefix:
First Name:IDALIA
Middle Name:VANESSA
Last Name:ROSADO-TORRES
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 7068
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23707-0068
Mailing Address - Country:US
Mailing Address - Phone:757-686-3508
Mailing Address - Fax:757-686-0541
Practice Address - Street 1:3802 POPLAR HILL RD
Practice Address - Street 2:STE C
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23321-5531
Practice Address - Country:US
Practice Address - Phone:757-673-8383
Practice Address - Fax:757-483-9350
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2015-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
VA0101256229207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD411084600Medicaid
MD52-1888193OtherTAX ID #