Provider Demographics
NPI:1134235336
Name:MODESTO, MARIA HOPE MAYOR (MD)
Entity type:Individual
Prefix:
First Name:MARIA HOPE
Middle Name:MAYOR
Last Name:MODESTO
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 1:114 GATEWAY CORPORATE BLVD.
Mailing Address - Street 2:SUITE 450
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29203
Mailing Address - Country:US
Mailing Address - Phone:803-865-4950
Mailing Address - Fax:803-865-4955
Practice Address - Street 1:114 GATEWAY CORPORATE BLVD.
Practice Address - Street 2:SUITE 450
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203
Practice Address - Country:US
Practice Address - Phone:803-865-4950
Practice Address - Fax:803-865-4955
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2016-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RILP00146207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine