Individual
GINA NICOLE MOODY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
745 W STATE ST, 510, COLUMBUS, OH 43222-1515
(614) 464-0788
(614) 464-0295
Mailing address
745 W STATE ST, 510, COLUMBUS, OH 43222-1515
(614) 464-0788
(614) 464-0295
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
34-009373
OH
207RP1001X
Pulmonary Disease Physician
34009373
OH
208M00000X
Hospitalist Physician
34.009373
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000706454
ANTHEM
OH
05
—
2932974
—
OH
05
—
3810019460
—
WV
Enumeration date
06/05/2008
Last updated
05/13/2013
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