MEDICARE: ANGELA ANTOINE MD

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	207Q00000X	Family Medicine Physician	0102037192	VA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	PO0138251	OTHER	VA	RR MEDICARE

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
3	541595397	OTHER	VA	TRICARE
4	541595397	OTHER	VA	MID ATLANTIC SOLUTIONS
5	79396	OTHER	VA	SENTARA/OPTIMA
6	7688601	OTHER	VA	AETNA
7	541595397	OTHER	VA	CIGNA
8	541595397	OTHER	VA	VIRGINIA HEALTH NETWORK
9	143855	OTHER	VA	ANTHEM
10	541595397	OTHER	VA	PRIVATE HEALTHCARE SYSTEM

General Provider Information

NPI Number	:	1134192479
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELA ANTOINE MD

Provider Business Mailing Address
First Line	:	3241 WESTERN BRANCH BLVD
Second Line	:
City	:	CHESAPEAKE
State	:	VA
Zip	:	23321-5260
Country	:	US
Telephone Number	:	757-686-3508
Fax Number	:	757-686-0230

Provider Business Practice Location Address
First Line	:	6632 INDIAN RIVER RD
Second Line	:	SUITE 103
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23464-3442
Country	:	US
Telephone Number	:	757-424-4442
Fax Number	:	757-523-4765

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/08/2006
Last Update Date	:	04/09/2010

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Directions to “ ANGELA ANTOINE MD” Practice Location

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