MEDICARE: MR. GARY BLAIR MOSS MD

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	207K00000X	Allergy & Immunology Physician	0101049940	VA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	CF1969	OTHER		RAILROAD MEDICARE GROUP #
8	C01592	OTHER	VA	MEDICARE GROUP #

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1588665137	OTHER		INDIVIDUAL NPI#
2	56572	OTHER	VA	OPTIMA/SENTARA
4	1326022880	OTHER		GROUP NPI#
5	322700	OTHER	VA	ANTHEM
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	348140	OTHER	VA	MAMSI

General Provider Information

NPI Number	:	1588665137
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. GARY BLAIR MOSS MD

Provider Business Mailing Address
First Line	:	1704 SIR WILLIAM OSLER DR
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23454-3003
Country	:	US
Telephone Number	:	757-481-4383
Fax Number	:	757-481-4611

Provider Business Practice Location Address
First Line	:	1704 SIR WILLIAM OSLER DR
Second Line	:	SUITE 300
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23454-3003
Country	:	US
Telephone Number	:	757-481-4383
Fax Number	:	757-481-4611

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

Provider Enumeration Date	:	08/04/2005
Last Update Date	:	08/02/2016

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Directions to “ MR. GARY BLAIR MOSS MD” Practice Location

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