Individual
ANGELA ANTOINE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
6632 INDIAN RIVER RD, SUITE 103, VIRGINIA BEACH, VA 23464-3442
(757) 424-4442
(757) 523-4765
Mailing address
3241 WESTERN BRANCH BLVD, CHESAPEAKE, VA 23321-5260
(757) 686-3508
(757) 686-0230
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
0102037192
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010079586
—
VA
01
—
143855
ANTHEM
VA
01
—
541595397
TRICARE
VA
01
—
7688601
AETNA
VA
01
—
79396
SENTARA/OPTIMA
VA
01
—
PO0138251
RR MEDICARE
VA
Enumeration date
02/08/2006
Last updated
04/09/2010
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