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Individual

DR. STEPHANIE ANN MOODY ANTONIO

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MD

Contact information

Practice address
600 GRESHAM DR, SUITE 1100, NORFOLK, VA 23507-1904
(757) 388-6200
(757) 388-6201
Mailing address
PO BOX 936, NORFOLK, VA 23501-0936
(757) 388-6200
(757) 388-6201

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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