Provider Demographics
NPI:1497876767
Name:THRASHER, MODINA RICHIA (MD)
Entity Type:Individual
Prefix:
First Name:MODINA
Middle Name:RICHIA
Last Name:THRASHER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32355 CAPITOL
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48150
Mailing Address - Country:US
Mailing Address - Phone:734-573-3500
Mailing Address - Fax:734-524-9316
Practice Address - Street 1:32355 CAPITOL
Practice Address - Street 2:LABORATORY CORPORATION OF AMERICA
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48150
Practice Address - Country:US
Practice Address - Phone:734-573-3500
Practice Address - Fax:734-524-9316
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301053689207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
G21007Medicare UPIN