1477519403 NPI number — SHEELA D MODIN M.D.

Table of content: SHEELA D MODIN M.D. (NPI 1477519403)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477519403 NPI number — SHEELA D MODIN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MODIN
Provider First Name:
SHEELA
Provider Middle Name:
D
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PUTTASWAMAIAH
Provider Other First Name:
SHEELA
Provider Other Middle Name:
DHARSANI
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1477519403
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/18/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 418837
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOSTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02241-8837
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
888-846-5527
Provider Business Mailing Address Fax Number:
607-324-2369

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2121 MEDICAL PARK DR
Provider Second Line Business Practice Location Address:
SUITE 4
Provider Business Practice Location Address City Name:
SILVER SPRING
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20902-4054
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-681-4422
Provider Business Practice Location Address Fax Number:
301-681-1684
Provider Enumeration Date:
04/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2085R0001X , with the licence number:  D0045119 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 8676971005 . This is a "CIGNA" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 022600900 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 11931 . This is a "JOHNS HOPKINS HEALTHCARE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 270567 . This is a "MAMSI" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 29020004 . This is a "CAREFIRST BC/BS" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: 3624169 . This is a "AETNA HMO" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 60332702 . This is a "CAREFIRST BC/BS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 00002153455 02 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 034402500 , issued by the state of ( DC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 497790 . This is a "NATIONAL CAPITOL PPO" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 1179916 . This is a "FIRST HEALTH/CCN" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 52127 . This is a "AMERIGROUP" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 7509331 . This is a "AETNA PPO/POS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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