MEDICARE: YASMEEN A MOODY MD PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208200000X	Plastic Surgery Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1609827377
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	YASMEEN A MOODY MD PC

Provider Business Mailing Address
First Line	:	PO BOX 366
Second Line	:	202 TAUGHANNOCK BLVD
City	:	ITHACA
State	:	NY
Zip	:	14851-0366
Country	:	US
Telephone Number	:	607-277-3257
Fax Number	:	607-277-4056

Provider Business Practice Location Address
First Line	:	1 FIRST STREET
Second Line	:
City	:	WATKINS GLEN
State	:	NY
Zip	:	14891
Country	:	US
Telephone Number	:	607-535-4644
Fax Number	:	607-535-4744

Authorized Official
Title or Position	:	OWNER
Name	:	DR. YASMEEN A MOODY
Credential	:	MD
Telephone Number	:	607-535-4644

Provider Enumeration Date	:	05/15/2006
Last Update Date	:	02/05/2008

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