Provider Demographics
NPI:1033179791
Name:MODARELLI, DANIEL CHRISTOPHER (DO)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:CHRISTOPHER
Last Name:MODARELLI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7580 AUBURN ROAD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:CONCORD TWP
Mailing Address - State:OH
Mailing Address - Zip Code:44077-9406
Mailing Address - Country:US
Mailing Address - Phone:440-352-0400
Mailing Address - Fax:440-352-4535
Practice Address - Street 1:7580 AUBURN ROAD
Practice Address - Street 2:SUITE 202
Practice Address - City:CONCORD TWP
Practice Address - State:OH
Practice Address - Zip Code:44077-9406
Practice Address - Country:US
Practice Address - Phone:440-352-0400
Practice Address - Fax:440-352-4535
Is Sole Proprietor?:No
Enumeration Date:2006-03-27
Last Update Date:2021-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34-006969207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH264200000OtherFEDERAL BLACK LUNG
OH000000339418OtherANTHEM
OH2109444Medicaid
OH6600162OtherUNITED HEALTHCARE
OH264200000OtherDEPT OF LABOR
OH80507OtherQUALCHOICE
OHG81869Medicare UPIN
OH2109444Medicaid
OHP00076759Medicare ID - Type UnspecifiedRAILROAD