Provider Demographics
NPI:1720033855
Name:MOSS, MARY THOMAS (MD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:THOMAS
Last Name:MOSS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:503 E BELL ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37130-3052
Mailing Address - Country:US
Mailing Address - Phone:615-907-2040
Mailing Address - Fax:615-907-2827
Practice Address - Street 1:503 E BELL ST
Practice Address - Street 2:SUITE 200
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37130-3052
Practice Address - Country:US
Practice Address - Phone:615-907-2040
Practice Address - Fax:615-907-2827
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2020-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN18999207V00000X, 207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3038905Medicaid
TN3038905Medicaid
3039800Medicare ID - Type Unspecified