Individual
MR. GARY BLAIR MOSS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1704 SIR WILLIAM OSLER DR, SUITE 300, VIRGINIA BEACH, VA 23454-3003
(757) 481-4383
(757) 481-4611
Mailing address
1704 SIR WILLIAM OSLER DR, VIRGINIA BEACH, VA 23454-3003
(757) 481-4383
(757) 481-4611
Taxonomy
Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
Primary
0101049940
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1326022880
GROUP NPI#
—
01
—
1588665137
INDIVIDUAL NPI#
—
01
—
322700
ANTHEM
VA
01
—
348140
MAMSI
VA
01
—
56572
OPTIMA/SENTARA
VA
05
—
5803071
—
VA
01
—
C01592
MEDICARE GROUP #
VA
01
—
CF1969
RAILROAD MEDICARE GROUP #
—
Enumeration date
08/04/2005
Last updated
08/02/2016
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