Provider Demographics
NPI:1659342715
Name:BERMISA, ROSARIO SALGADO (MD)
Entity Type:Individual
Prefix:DR
First Name:ROSARIO
Middle Name:SALGADO
Last Name:BERMISA
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 1:9 ENSIGN SPENCE
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23185-5559
Mailing Address - Country:US
Mailing Address - Phone:757-259-2243
Mailing Address - Fax:
Practice Address - Street 1:110 AMERICAN LEGION RD
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23321-5651
Practice Address - Country:US
Practice Address - Phone:757-673-6801
Practice Address - Fax:757-673-6808
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101053355208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
F00098Medicare UPIN