Provider Demographics
NPI:1568456085
Name:MODIC, CHRISTOPHER W (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:W
Last Name:MODIC
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1226 STOLTZ RD
Mailing Address - Street 2:
Mailing Address - City:BETHEL PARK
Mailing Address - State:PA
Mailing Address - Zip Code:15102-3616
Mailing Address - Country:US
Mailing Address - Phone:412-835-6600
Mailing Address - Fax:412-835-3456
Practice Address - Street 1:1000 BOWER HILL RD
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15243-1873
Practice Address - Country:US
Practice Address - Phone:412-835-6600
Practice Address - Fax:412-835-3456
Is Sole Proprietor?:No
Enumeration Date:2005-09-12
Last Update Date:2012-02-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD014701E2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0009470510001Medicaid
D68782Medicare UPIN
PA0009470510001Medicaid