Provider Demographics
NPI:1700967627
Name:MODERY, MARSHA E (MD)
Entity Type:Individual
Prefix:DR
First Name:MARSHA
Middle Name:E
Last Name:MODERY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1451 HILLSIDE DR
Mailing Address - Street 2:NEWTON HALL
Mailing Address - City:CLARKS SUMMIT
Mailing Address - State:PA
Mailing Address - Zip Code:18411-9504
Mailing Address - Country:US
Mailing Address - Phone:570-587-7254
Mailing Address - Fax:570-587-7270
Practice Address - Street 1:1451 HILLSIDE DR
Practice Address - Street 2:NEWTON HALL
Practice Address - City:CLARKS SUMMIT
Practice Address - State:PA
Practice Address - Zip Code:18411-9504
Practice Address - Country:US
Practice Address - Phone:570-587-7254
Practice Address - Fax:570-587-7270
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2018-11-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD039611E207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1003085180065Medicaid
PA679959KJKOtherMED. ID
PA1003085180065Medicaid
PAF32581Medicare UPIN