Provider Demographics
NPI:1629237417
Name:MODI, DANESH S (DO)
Entity Type:Individual
Prefix:DR
First Name:DANESH
Middle Name:S
Last Name:MODI
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:207 N BROAD ST
Mailing Address - Street 2:FL 3
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-1500
Mailing Address - Country:US
Mailing Address - Phone:610-279-1370
Mailing Address - Fax:610-279-1372
Practice Address - Street 1:609 W. GERMANTOWN PIKE
Practice Address - Street 2:MEDICAL ARTS BUILDING SUITE 120
Practice Address - City:EAST NORRITON
Practice Address - State:PA
Practice Address - Zip Code:19403
Practice Address - Country:US
Practice Address - Phone:610-279-1370
Practice Address - Fax:610-279-1372
Is Sole Proprietor?:No
Enumeration Date:2008-06-05
Last Update Date:2023-07-13
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Provider Licenses
StateLicense IDTaxonomies
PAOS015569207RC0001X, 207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103123660Medicaid
PA391808Medicare PIN