Individual
GARY MOELICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
AA
Contact information
Practice address
100 HOSPITAL DRIVE, BENNINGTON, VT 05201
(802) 442-6361
Mailing address
100 HOSPITAL DRIVE, BENNINGTON, VT 05201
(802) 442-6361
Taxonomy
Speciality
Code
Description
License number
State
367H00000X
Anesthesiologist Assistant
002862
GA
367H00000X
Anesthesiologist Assistant
Primary
AAA0000021
VT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1014522
—
VT
Enumeration date
10/23/2006
Last updated
03/28/2008
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