Provider Demographics
NPI:1477519403
Name:MODIN, SHEELA D (MD)
Entity Type:Individual
Prefix:
First Name:SHEELA
Middle Name:D
Last Name:MODIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SHEELA
Other - Middle Name:DHARSANI
Other - Last Name:PUTTASWAMAIAH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 418837
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-8837
Mailing Address - Country:US
Mailing Address - Phone:888-846-5527
Mailing Address - Fax:607-324-2369
Practice Address - Street 1:2121 MEDICAL PARK DR
Practice Address - Street 2:SUITE 4
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20902-4054
Practice Address - Country:US
Practice Address - Phone:301-681-4422
Practice Address - Fax:301-681-1684
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2012-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00451192085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD8676971005OtherCIGNA
MD022600900Medicaid
MD11931OtherJOHNS HOPKINS HEALTHCARE
MD270567OtherMAMSI
DC29020004OtherCAREFIRST BC/BS
MD3624169OtherAETNA HMO
MD60332702OtherCAREFIRST BC/BS
MD00002153455 02OtherUNITED HEALTHCARE
DC034402500Medicaid
MD497790OtherNATIONAL CAPITOL PPO
MD1179916OtherFIRST HEALTH/CCN
MD52127OtherAMERIGROUP
MD7509331OtherAETNA PPO/POS
MD00002153455 02OtherUNITED HEALTHCARE
MD11931OtherJOHNS HOPKINS HEALTHCARE
MD497790OtherNATIONAL CAPITOL PPO
MD001725S29Medicare PIN