Provider Demographics
NPI:1831118991
Name:DASH-MODI, ANITA (MD)
Entity type:Individual
Prefix:DR
First Name:ANITA
Middle Name:
Last Name:DASH-MODI
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 1:1 PARK WEST BLVD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44320
Mailing Address - Country:US
Mailing Address - Phone:330-864-8060
Mailing Address - Fax:330-864-8074
Practice Address - Street 1:1 PARK WEST BLVD
Practice Address - Street 2:SUITE 150
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44320
Practice Address - Country:US
Practice Address - Phone:330-864-8060
Practice Address - Fax:330-864-8074
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35074825D207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2079665Medicaid
000000126057OtherANTHEM
OH2079665Medicaid
000000126057OtherANTHEM