Provider Demographics
NPI:1285196873
Name:WHITE, ROSA VIRGINIA (MD)
Entity type:Individual
Prefix:
First Name:ROSA
Middle Name:VIRGINIA
Last Name:WHITE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ROSA
Other - Middle Name:VIRGINIA
Other - Last Name:GUEDEZ BAUTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3435 W BROADWAY AVE STE 1135
Mailing Address - Street 2:
Mailing Address - City:ROBBINSDALE
Mailing Address - State:MN
Mailing Address - Zip Code:55422-2974
Mailing Address - Country:US
Mailing Address - Phone:763-581-2800
Mailing Address - Fax:
Practice Address - Street 1:3435 W BROADWAY AVE STE 1135
Practice Address - Street 2:
Practice Address - City:ROBBINSDALE
Practice Address - State:MN
Practice Address - Zip Code:55422-2974
Practice Address - Country:US
Practice Address - Phone:763-581-2800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-02
Last Update Date:2025-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN80098207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology