Provider Demographics
NPI:1396710612
Name:BERCASIO, ROLAND M (MD)
Entity type:Individual
Prefix:DR
First Name:ROLAND
Middle Name:M
Last Name:BERCASIO
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:11803 JEFFERSON AVE
Mailing Address - Street 2:STE 100
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606-2565
Mailing Address - Country:US
Mailing Address - Phone:757-594-1840
Mailing Address - Fax:757-275-9785
Practice Address - Street 1:11803 JEFFERSON AVE
Practice Address - Street 2:STE 100
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-2565
Practice Address - Country:US
Practice Address - Phone:757-594-1840
Practice Address - Fax:757-275-9785
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2013-10-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0101054181207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA005632994Medicaid
VA005632994Medicaid
080005533Medicare ID - Type Unspecified