# THOMAS AE MOSELEY

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Newport Pediatrics & Adolescent Medicine PLLC
- **Organization subpart:** No

## Provider details

- **NPI number:** 1366515249
- **Authorized official:** MR. THOMAS AE MOSELEY III MD (OWNER)
- **Authorized official phone:** (802) 334-5929

## Contact information

- **Practice address:** 121 MEDICAL VILLAGE DRIVE, NEWPORT, VT 05855
- **Practice address phone:** (802) 334-6929
- **Practice address fax:** (802) 784-1051
- **Mailing address:** 121 MEDICAL VILLAGE DRIVE, NEWPORT, VT 05855
- **Mailing address phone:** (802) 334-6929
- **Mailing address fax:** (802) 784-1051

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 1010022369 | VT | — |
| 208000000X | Pediatrics Physician | 0420010849 | VT | — |
| 208000000X | Pediatrics Physician | 420006774 | VT | Yes |

## Other

- **Enumeration date:** 11/16/2006
- **Last updated:** 03/14/2012

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 0473814 | — | VT |