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Individual

MR. THOMAS U. MOODY SR.

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PHYSICIAN ASSISTANT

Contact information

Practice address
21017 STATE ROUTE 12F, WATERTOWN, NY 13601-1078
(315) 786-3436
Mailing address
26775 ANABEL AVE, EVANS MILLS, NY 13637-3212
(315) 629-1443

Taxonomy

Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
001884
CT
363AM0700X
Medical Physician Assistant
Primary
OO9271
NY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
4151147
MVP HEALTHCARE PIN #
NY
Enumeration date
10/19/2006
Last updated
07/08/2007
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