Provider Demographics
NPI:1205864329
Name:COBB, DONALD MATTHEW (DO)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:MATTHEW
Last Name:COBB
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 1:262 OVERLAKE DR
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:VA
Mailing Address - Zip Code:24201-1806
Mailing Address - Country:US
Mailing Address - Phone:276-628-9331
Mailing Address - Fax:
Practice Address - Street 1:HOSPITAL DRIVE
Practice Address - Street 2:GLENROCHIE PROFESSIONAL BLDG
Practice Address - City:ABINGDON
Practice Address - State:VA
Practice Address - Zip Code:24210
Practice Address - Country:US
Practice Address - Phone:276-628-9331
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01022018452085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAG42695Medicare UPIN