Provider Demographics
NPI:1598882037
Name:MODY, SUREN K (MD, FRCS)
Entity Type:Individual
Prefix:DR
First Name:SUREN
Middle Name:K
Last Name:MODY
Suffix:
Gender:M
Credentials:MD, FRCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1042
Mailing Address - Street 2:
Mailing Address - City:CHRISTIANSTED
Mailing Address - State:VI
Mailing Address - Zip Code:00821-1042
Mailing Address - Country:US
Mailing Address - Phone:340-778-5599
Mailing Address - Fax:340-778-5599
Practice Address - Street 1:BEESTON HILL MEDICAL CENTER SUITE #9
Practice Address - Street 2:
Practice Address - City:CHRISTIANSTED
Practice Address - State:VI
Practice Address - Zip Code:00820
Practice Address - Country:US
Practice Address - Phone:340-778-5599
Practice Address - Fax:340-778-5599
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VI329174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VI24366Medicare ID - Type UnspecifiedOPHTHALMOLOGIST
VIG42956Medicare UPIN