Provider Demographics
NPI:1497186480
Name:THOMAS L MOFFATT, MD
Entity type:Organization
Organization Name:THOMAS L MOFFATT, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:MOFFATT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:804-320-0929
Mailing Address - Street 1:2501 E FRANKLIN ST UNIT 2
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23223-7884
Mailing Address - Country:US
Mailing Address - Phone:804-320-0929
Mailing Address - Fax:804-320-0929
Practice Address - Street 1:2501 E FRANKLIN ST UNIT 2
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23223-7884
Practice Address - Country:US
Practice Address - Phone:804-320-0929
Practice Address - Fax:804-320-0929
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-02
Last Update Date:2015-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101028122207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty