Provider Demographics
NPI:1396897799
Name:MOODY, GLYNIS (MD)
Entity type:Individual
Prefix:DR
First Name:GLYNIS
Middle Name:
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 1:985 PRINCE FREDERICK BLVD STE 201
Mailing Address - Street 2:
Mailing Address - City:PRINCE FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:20678-3492
Mailing Address - Country:US
Mailing Address - Phone:410-535-2005
Mailing Address - Fax:410-535-4850
Practice Address - Street 1:10845 TOWN CENTER BLVD STE 204
Practice Address - Street 2:
Practice Address - City:DUNKIRK
Practice Address - State:MD
Practice Address - Zip Code:20754-2712
Practice Address - Country:US
Practice Address - Phone:410-535-2005
Practice Address - Fax:410-535-4850
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD50233207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD2384434OtherAETNA HMO PCP
MD54413801OtherCAREFIRST OF MARYLAND
MD7010013OtherAETNA NON-HMO
MD763260600Medicaid
MD8126360OtherMAMSI HMO
DCC0410031OtherCAREFIRST OF DC
MDP00161495OtherRAILROAD MEDICARE
MD54413801OtherCAREFIRST OF MARYLAND
MD763260600Medicaid