Provider Demographics
NPI:1669475646
Name:MODY, NARESH V (MD)
Entity Type:Individual
Prefix:
First Name:NARESH
Middle Name:V
Last Name:MODY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:605 N WASHINGTON AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:TITUSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32796-2152
Mailing Address - Country:US
Mailing Address - Phone:321-383-7600
Mailing Address - Fax:321-383-8111
Practice Address - Street 1:605 N WASHINGTON AVE STE 100
Practice Address - Street 2:
Practice Address - City:TITUSVILLE
Practice Address - State:FL
Practice Address - Zip Code:32796-2152
Practice Address - Country:US
Practice Address - Phone:321-383-7600
Practice Address - Fax:321-383-8111
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2013-04-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FL62797207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
060033063OtherRAILROAD MC
A28577Medicare UPIN
060033063OtherRAILROAD MC