Provider Demographics
NPI:1164557542
Name:MODY, MAHENDRA I (MD)
Entity Type:Individual
Prefix:DR
First Name:MAHENDRA
Middle Name:I
Last Name:MODY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 JUSTICE DR
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18940-1106
Mailing Address - Country:US
Mailing Address - Phone:215-968-1871
Mailing Address - Fax:
Practice Address - Street 1:1201 LANGHORNE-NEWTOWN RD.
Practice Address - Street 2:ST.MARY MEDICAL CENTER
Practice Address - City:LANGHORNE
Practice Address - State:PA
Practice Address - Zip Code:19047
Practice Address - Country:US
Practice Address - Phone:215-710-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD018611E207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine