Provider Demographics
NPI:1003813346
Name:MOSELEY, THOMAS ADDIS EMMET III (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:ADDIS EMMET
Last Name:MOSELEY
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:121 MEDICAL VILLAGE DR
Mailing Address - Street 2:NEWPORT PEDIATRICS AND ADOLESCENT MEDICINE PLLC
Mailing Address - City:NEWPORT
Mailing Address - State:VT
Mailing Address - Zip Code:05855-9834
Mailing Address - Country:US
Mailing Address - Phone:802-334-5929
Mailing Address - Fax:
Practice Address - Street 1:121 MEDICAL VILLAGE DR
Practice Address - Street 2:NEWPORT PEDIATRICS AND ADOLESCENT MEDICINE PLLC
Practice Address - City:NEWPORT
Practice Address - State:VT
Practice Address - Zip Code:05855-9834
Practice Address - Country:US
Practice Address - Phone:802-334-5929
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT042-0006774208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0005451Medicaid
VT0005451Medicaid