Provider Demographics
NPI:1265405260
Name:COSSIO, MOISES RIMMER (DO)
Entity type:Individual
Prefix:DR
First Name:MOISES
Middle Name:RIMMER
Last Name:COSSIO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 936
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23501-0936
Mailing Address - Country:US
Mailing Address - Phone:757-446-5758
Mailing Address - Fax:757-446-5242
Practice Address - Street 1:2001 CRYSTAL SPRING AVE SW
Practice Address - Street 2:SUITE 205
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24014-2462
Practice Address - Country:US
Practice Address - Phone:540-985-8505
Practice Address - Fax:540-344-3313
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102201314207R00000X, 207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAPAROtherUSA MANAGED CARE
VAPAROtherCIGNA
VAPAROtherAETNA
NC00864OtherMEDICAID BC BS
VAPAROtherCORVEL/CORCARE
VAPAROtherVIRGINIA PREMIER HEALTH
VAPAROtherVIRGINIA HEALTH NETWORK
VAVV1744AOtherMEDICARE
VA177113OtherANTHEM
VA96131OtherSENTARA OPTIMA
VAPAROtherFIRST HEALTH COMMERCIAL/SOUTHERN HEALTH/COVENTRY
VA3159697OtherUHC/MAMSI
VA-029OtherTRICARE/CHAMPUS
VA010160511Medicaid
NC5900864Medicaid
VAPAROtherMULTIPLAN
VAPAROtherMULTIPLAN
NC5900864Medicaid
VAP00305237Medicare PIN