Provider Demographics
NPI:1518266519
Name:MODY, RITA D (MD)
Entity Type:Individual
Prefix:MRS
First Name:RITA
Middle Name:D
Last Name:MODY
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 1:4403 ENCHANTED SPRING CT.
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479
Mailing Address - Country:US
Mailing Address - Phone:281-410-1707
Mailing Address - Fax:
Practice Address - Street 1:8540 MIDLAND CT
Practice Address - Street 2:
Practice Address - City:GREENDALE
Practice Address - State:WI
Practice Address - Zip Code:53129-1033
Practice Address - Country:US
Practice Address - Phone:414-529-2894
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-16
Last Update Date:2013-03-11
Deactivation Date:2011-12-16
Deactivation Code:
Reactivation Date:2013-03-11
Provider Licenses
StateLicense IDTaxonomies
WI21405207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine