| Doctor Name: | DR. RUSTICO TOLENTINO GOTICO |
| NPI Number: | 1326020728 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.D. |
| License Number: | 0101025518 |
| Business Practice Address: | 4601 Ironbound Rd. Eastern State Hospital Williamsburg, VA - 231878791 |
| Business Phone Number: | 7572535285 |
| Business Fax Number: | |
| Mailing Address: | 4908 Burnley Dr, WILLIAMSBURG |
| State: | VA |
| Postal Code: | 231888802 |
| Phone Number: | 7572294391 |
| Fax Number: | |
| NPI Enumeration Date: | 11/19/2005 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 0101025518 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | VA |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |