MEDICARE: THOMAS L MOFFATT M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RN0300X	Nephrology Physician	0101028122	VA

General Provider Information

NPI Number	:	1790783231
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THOMAS L MOFFATT M.D.

Provider Business Mailing Address
First Line	:	2501 E FRANKLIN ST UNIT 2
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23223-7884
Country	:	US
Telephone Number	:	804-320-0929
Fax Number	:	804-320-0929

Provider Business Practice Location Address
First Line	:	2501 E FRANKLIN ST UNIT 2
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23223-7884
Country	:	US
Telephone Number	:	804-320-0929
Fax Number	:	804-320-0929

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/08/2005
Last Update Date	:	04/08/2015

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