Provider Demographics
NPI:1134192479
Name:ANTOINE, ANGELA (MD)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:ANTOINE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3241 WESTERN BRANCH BLVD
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23321-5260
Mailing Address - Country:US
Mailing Address - Phone:757-686-3508
Mailing Address - Fax:757-686-0230
Practice Address - Street 1:6632 INDIAN RIVER RD
Practice Address - Street 2:SUITE 103
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23464-3442
Practice Address - Country:US
Practice Address - Phone:757-424-4442
Practice Address - Fax:757-523-4765
Is Sole Proprietor?:No
Enumeration Date:2006-02-08
Last Update Date:2010-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102037192207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010079586Medicaid
VAPO0138251OtherRR MEDICARE
VA541595397OtherTRICARE
VA541595397OtherMID ATLANTIC SOLUTIONS
VA79396OtherSENTARA/OPTIMA
VA7688601OtherAETNA
VA541595397OtherCIGNA
VA541595397OtherVIRGINIA HEALTH NETWORK
VA143855OtherANTHEM
VA541595397OtherPRIVATE HEALTHCARE SYSTEM
VA541595397OtherVIRGINIA HEALTH NETWORK
VA541595397OtherCIGNA