Provider Demographics
NPI:1013239995
Name:DEL ROSARIO, JOSEPHINE VIDA (PA-C)
Entity type:Individual
Prefix:MS
First Name:JOSEPHINE
Middle Name:VIDA
Last Name:DEL ROSARIO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:JOSEPHINE
Other - Middle Name:DEL ROSARIO
Other - Last Name:MCDUFFIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 751069
Mailing Address - Street 2:ECU PHYSICIANS
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1069
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:628 E 12TH ST
Practice Address - Street 2:ECU PHYSICIANS EMERGENCY MEDICINE-BEAUFORT VIDANT
Practice Address - City:WASHINGTON
Practice Address - State:NC
Practice Address - Zip Code:27889-3409
Practice Address - Country:US
Practice Address - Phone:252-975-4319
Practice Address - Fax:252-975-4185
Is Sole Proprietor?:No
Enumeration Date:2010-02-19
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-02209363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1560WOtherBCBS NC
NC1013239995Medicaid
NCNC98080322Medicare PIN