MEDICARE: MRS. TESSIE OTERO-TRUITT MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RE0101X	Endocrinology, Diabetes & Metabolism Physician	0101052342	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	281110	OTHER	VA	ANTHEM
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	44141	OTHER	VA	OPTIMA

General Provider Information

NPI Number	:	1700881885
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TESSIE OTERO-TRUITT MD

Provider Business Mailing Address
First Line	:	2232 WILBORN AVE
Second Line	:	STE B
City	:	SOUTH BOSTON
State	:	VA
Zip	:	24592-1662
Country	:	US
Telephone Number	:	434-575-5844
Fax Number	:	434-575-0862

Provider Business Practice Location Address
First Line	:	2232 WILBORN AVE
Second Line	:	STE B
City	:	SOUTH BOSTON
State	:	VA
Zip	:	24592-1662
Country	:	US
Telephone Number	:	434-575-5844
Fax Number	:	434-575-0862

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/16/2005
Last Update Date	:	01/14/2016

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