Provider Demographics
NPI:1700881885
Name:OTERO-TRUITT, TESSIE (MD)
Entity Type:Individual
Prefix:MRS
First Name:TESSIE
Middle Name:
Last Name:OTERO-TRUITT
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 1:2232 WILBORN AVE
Mailing Address - Street 2:STE B
Mailing Address - City:SOUTH BOSTON
Mailing Address - State:VA
Mailing Address - Zip Code:24592-1662
Mailing Address - Country:US
Mailing Address - Phone:434-575-5844
Mailing Address - Fax:434-575-0862
Practice Address - Street 1:2232 WILBORN AVE
Practice Address - Street 2:STE B
Practice Address - City:SOUTH BOSTON
Practice Address - State:VA
Practice Address - Zip Code:24592-1662
Practice Address - Country:US
Practice Address - Phone:434-575-5844
Practice Address - Fax:434-575-0862
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2016-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101052342207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA281110OtherANTHEM
VA006082807Medicaid
VA44141OtherOPTIMA
VA44141OtherOPTIMA
VA006082807Medicaid