Individual provider · NPI-1

Dr. Anthony Le Roy Moulton, MD

Thoracic Surgery (Cardiothoracic Vascular Surgery) · Providence, RI

NPI number1689695736

StatusActive

Last updated in NPPESNov 27, 2007

Details

NPI: 1689695736
Entity type: Individual (NPI-1)
Name: Dr. Anthony Le Roy Moulton
Credential: MD
Sex: Male
Sole proprietor: Yes
Enumeration date: Jul 22, 2006
Last updated: Nov 27, 2007

Taxonomy and licenses

Taxonomy code	Description	License	State	Primary
208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery)	079657	RI	Yes

Practice location

1 Randall Sq
Ste 414
Providence, RI 02904-2709

Phone 401-331-4175 · Fax 401-331-5718

Mailing address

1 Randall Sq
Ste 414
Providence, RI 02904-2709

Phone 401-331-4175 · Fax 401-331-5718

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