Provider Demographics
NPI:1003230343
Name:TUSHAR R. MODI, M.D. INC.
Entity Type:Organization
Organization Name:TUSHAR R. MODI, M.D. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:TUSHAR
Authorized Official - Middle Name:R
Authorized Official - Last Name:MODI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:209-529-9600
Mailing Address - Street 1:413 E ORANGEBURG AVE STE A
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95350-5369
Mailing Address - Country:US
Mailing Address - Phone:209-529-9600
Mailing Address - Fax:209-544-2620
Practice Address - Street 1:413 E ORANGEBURG AVE STE A
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-5369
Practice Address - Country:US
Practice Address - Phone:209-529-9600
Practice Address - Fax:209-544-2620
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-06
Last Update Date:2022-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty