Provider Demographics
NPI:1578643227
Name:MODY, SATISH K (MD)
Entity Type:Individual
Prefix:
First Name:SATISH
Middle Name:K
Last Name:MODY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:360 W RUDDLE ST
Mailing Address - Street 2:
Mailing Address - City:COALDALE
Mailing Address - State:PA
Mailing Address - Zip Code:18218-1027
Mailing Address - Country:US
Mailing Address - Phone:570-645-8256
Mailing Address - Fax:570-645-8875
Practice Address - Street 1:24 S 18TH ST
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18104-5622
Practice Address - Country:US
Practice Address - Phone:610-628-8372
Practice Address - Fax:610-628-8648
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2008-02-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMD034813L207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA159488Medicare PIN