MEDICARE: DR. RAFFAELLA DEROSA M.D.

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	208800000X	Urology Physician	306408	NC
2	208800000X	Urology Physician	16588	HI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1568756351
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RAFFAELLA DEROSA M.D.

Provider Business Mailing Address
First Line	:	2817 ROCK MERRITT
Second Line	:
City	:	FORT BRAGG
State	:	NC
Zip	:	28310-5001
Country	:	US
Telephone Number	:	910-907-8236
Fax Number	:

Provider Business Practice Location Address
First Line	:	2817 ROCK MERRITT AVE WOMACK ARMY MEDICAL CENTER
Second Line	:
City	:	FORT BRAGG
State	:	NC
Zip	:	28310-5001
Country	:	US
Telephone Number	:	910-907-8922
Fax Number	:	910-907-6069

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

Provider Enumeration Date	:	06/09/2011
Last Update Date	:	04/13/2026

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