Provider Demographics
NPI:1285634253
Name:MOSS, BURTON ALAN (MD)
Entity type:Individual
Prefix:MR
First Name:BURTON
Middle Name:ALAN
Last Name:MOSS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:302A E LITTLE CREEK RD
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23505-2603
Mailing Address - Country:US
Mailing Address - Phone:757-583-4382
Mailing Address - Fax:757-480-3675
Practice Address - Street 1:302A E LITTLE CREEK RD
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23505-2603
Practice Address - Country:US
Practice Address - Phone:757-583-4382
Practice Address - Fax:757-480-3675
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101015046207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1285634253OtherINDIVIDUAL NPI#
VAC01592OtherMEDICARE GROUP #
VA1326022880OtherGROUP NPI#
VACN5602OtherRAILROAD MEDICARE GROUP #
VAC01592OtherMEDICARE GROUP #