Provider Demographics
NPI:1417960964
Name:MOODY, DEBORAH L (MD)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:L
Last Name:MOODY
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 1:4 RICHBELL CLOSE
Mailing Address - Street 2:
Mailing Address - City:SCARSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10583-4424
Mailing Address - Country:US
Mailing Address - Phone:914-472-9853
Mailing Address - Fax:914-472-9819
Practice Address - Street 1:4 RICHBELL CLOSE
Practice Address - Street 2:
Practice Address - City:SCARSDALE
Practice Address - State:NY
Practice Address - Zip Code:10583-4424
Practice Address - Country:US
Practice Address - Phone:914-472-9853
Practice Address - Fax:914-472-9819
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2009-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1700011207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYE20422Medicare UPIN
22F551Medicare ID - Type Unspecified