Provider Demographics
NPI:1790764314
Name:MODAWAL, ARVIND (MD)
Entity Type:Individual
Prefix:
First Name:ARVIND
Middle Name:
Last Name:MODAWAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2830 VICTORY PKWY STE 120
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45206-1786
Mailing Address - Country:US
Mailing Address - Phone:513-245-3052
Mailing Address - Fax:
Practice Address - Street 1:7700 UNIVERSITY CT STE 3100
Practice Address - Street 2:UNIVERSITY FAMILY PHYSICIANS-UNIVERSITY POINTE
Practice Address - City:WEST CHESTER
Practice Address - State:OH
Practice Address - Zip Code:45069-6545
Practice Address - Country:US
Practice Address - Phone:513-475-8264
Practice Address - Fax:513-475-8265
Is Sole Proprietor?:No
Enumeration Date:2006-01-12
Last Update Date:2013-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.070118207QG0300X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0274046Medicaid
OHMO0808589Medicare PIN
G35893Medicare UPIN
OHP00379582Medicare PIN
OH0274046Medicaid
MO0808581Medicare ID - Type Unspecified
OHMO7363801Medicare PIN
OHMO4238491Medicare PIN