Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 34-009373 | OH |
Y | 111NI0900X | Internist | 34-009373 | OH |
N | 207RP1001X | Pulmonary Disease | 34009373 | OH |
NPI | 1033378989 |
---|---|
Provider Name | Gina Nicole Moody |
First Address | Columbus, OH 43222-1515 |
Second Address | Columbus, OH 43222-1515 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/06/2008 |
Last Update Date | 13/05/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000706454 | ANTHEM (01) | OH |
2932974 | (05) | OH |
3810019460 | (05) | WV |