Individual
DR. STEPHANIE ANN MOODY ANTONIO
Active
Individual
DR. STEPHANIE ANN MOODY ANTONIO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
0101237385
VA
207YX0901X
Otology & Neurotology Physician
Primary
0101237385
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
-004
TRICARE/CHAMPUS
VA
05
—
010118387
—
VA
05
—
010170095
—
VA
01
—
067RG
BC/BS
NC
01
—
172403
ANTHEM
VA
01
—
174750
ANTHEM
VA
01
—
2129791
UHC/MAMSI
VA
05
—
89067RG
—
NC
01
—
91377
SENTARA OPTIMA
VA
01
—
PAR
USA MANAGED CARE
VA
Enumeration date
02/24/2006
Last updated
01/26/2009
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