1619081890 NPI number — DR. NEHAL P MODH MD

Table of content: DR. NEHAL P MODH MD (NPI 1619081890)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619081890 NPI number — DR. NEHAL P MODH MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MODH
Provider First Name:
NEHAL
Provider Middle Name:
P
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1619081890
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/03/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1125
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MARYLAND HEIGHTS
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63043-0125
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-432-2580
Provider Business Mailing Address Fax Number:
314-432-0223

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1145B E GANNON DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FESTUS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63028-2611
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
636-933-7673
Provider Business Practice Location Address Fax Number:
636-937-5001
Provider Enumeration Date:
08/18/2006

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: 2081P2900X , with the licence number:  2004028055 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2024 www.npivalidator.com