Provider Demographics
NPI:1639351679
Name:DIPA MODI, M.D.,P.A.
Entity Type:Organization
Organization Name:DIPA MODI, M.D.,P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:DIPABEN
Authorized Official - Middle Name:DHANANJAY
Authorized Official - Last Name:MODI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:832-964-9200
Mailing Address - Street 1:5919 BRIDLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77469-7304
Mailing Address - Country:US
Mailing Address - Phone:832-964-9200
Mailing Address - Fax:832-201-5658
Practice Address - Street 1:17510 W GRAND PKWY S
Practice Address - Street 2:#360,MEDICAL PLAZA
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-2645
Practice Address - Country:US
Practice Address - Phone:832-964-9200
Practice Address - Fax:832-201-5658
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-01
Last Update Date:2007-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM1244207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty