Provider Demographics
NPI:1194842567
Name:MODY & MILLER, M.D., P.A.
Entity Type:Organization
Organization Name:MODY & MILLER, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HARSHAD
Authorized Official - Middle Name:R
Authorized Official - Last Name:MODY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-760-5599
Mailing Address - Street 1:7310 RITCHIE HWY
Mailing Address - Street 2:SUITE 710
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061-3065
Mailing Address - Country:US
Mailing Address - Phone:410-760-5599
Mailing Address - Fax:410-760-3917
Practice Address - Street 1:7310 RITCHIE HWY
Practice Address - Street 2:SUITE 710
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-3065
Practice Address - Country:US
Practice Address - Phone:410-760-5599
Practice Address - Fax:410-760-3917
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-23
Last Update Date:2009-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN0400XChiropractic ProvidersChiropractorNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD652741800Medicaid
MD083421100Medicaid
MD779301400Medicaid
MD652741800Medicaid
MDF02930Medicare UPIN
MDJG30Medicare ID - Type UnspecifiedHARSHAD R. MODY, M.D.
MD779301400Medicaid
MD083421100Medicaid