=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700850419
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ROSA FUSTE M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/17/2006
-----------------------------------------------------
Last Update Date | 07/12/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1405 KILN CREEK PKWY
-----------------------------------------------------
City | NEWPORT NEWS
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23602-9700
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-283-6556
-----------------------------------------------------
Fax | 757-875-1028
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 209 JEFFERSONS HUNDRED
-----------------------------------------------------
City | WILLIAMSBURG
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23185-8909
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-564-8698
-----------------------------------------------------
Fax | 757-875-9700
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | 0101050349
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------