Provider Demographics
NPI:1639118920
Name:MODY, VAISHALI (MD)
Entity Type:Individual
Prefix:
First Name:VAISHALI
Middle Name:
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 1:1908 LENDEW ST
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27408-7007
Mailing Address - Country:US
Mailing Address - Phone:336-273-2835
Mailing Address - Fax:336-274-4594
Practice Address - Street 1:1908 LENDEW ST
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27408-7007
Practice Address - Country:US
Practice Address - Phone:336-273-2835
Practice Address - Fax:336-274-4594
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2011-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2010-01000207V00000X
IL036-109099207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILI16986Medicare UPIN
ILK27894Medicare PIN