Provider Demographics
NPI:1851451702
Name:MODY, BHARAT M (MD)
Entity Type:Individual
Prefix:DR
First Name:BHARAT
Middle Name:M
Last Name:MODY
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:PO BOX 308
Mailing Address - Street 2:
Mailing Address - City:GLASGOW
Mailing Address - State:KY
Mailing Address - Zip Code:42142-0308
Mailing Address - Country:US
Mailing Address - Phone:270-651-8789
Mailing Address - Fax:270-651-1126
Practice Address - Street 1:201 PROFESSIONAL PARK
Practice Address - Street 2:
Practice Address - City:GLASGOW
Practice Address - State:KY
Practice Address - Zip Code:42141
Practice Address - Country:US
Practice Address - Phone:270-651-8789
Practice Address - Fax:270-651-1126
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY18483208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64184831Medicaid
C69460Medicare UPIN
KY64184831Medicaid