Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 042-0006774 | VT |
NPI | 1003813346 |
---|---|
Provider Name | Dr. Thomas Addis Emmet Moseley III |
First Address | Newport, VT 05855-9834 |
Second Address | Newport, VT 05855-9834 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/07/2005 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0005451 | (05) | VT |
C65564 | (02) | VT |