Provider Demographics
NPI:1427033893
Name:RIMON, DESIDERIO J (MD)
Entity Type:Individual
Prefix:DR
First Name:DESIDERIO
Middle Name:J
Last Name:RIMON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:140 E FERRELL ST
Mailing Address - Street 2:PO BOX 623
Mailing Address - City:SOUTH HILL
Mailing Address - State:VA
Mailing Address - Zip Code:23970-2102
Mailing Address - Country:US
Mailing Address - Phone:434-774-2581
Mailing Address - Fax:434-447-4075
Practice Address - Street 1:1755 N MECKLENBURG AVE
Practice Address - Street 2:
Practice Address - City:SOUTH HILL
Practice Address - State:VA
Practice Address - Zip Code:23970-4080
Practice Address - Country:US
Practice Address - Phone:434-584-5436
Practice Address - Fax:434-584-5495
Is Sole Proprietor?:No
Enumeration Date:2005-12-08
Last Update Date:2019-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101-235416208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010015022Medicaid
002530C23Medicare PIN
VA010015022Medicaid
VAH97905Medicare UPIN