# MODERN MEDICAL GROUP PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1861051591
- **Authorized official:** IVETTE CINTRON-CUBERO FNP-C (OWNER/PRESIDENT)
- **Authorized official phone:** (704) 497-9544

## Contact information

- **Practice address:** 936 COX RD STE A, GASTONIA, NC 28054-3456
- **Practice address phone:** (704) 497-9544
- **Mailing address:** 10619 TROLLEY RUN DR, CORNELIUS, NC 28031-8303
- **Mailing address phone:** (704) 497-9544

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |
| 207R00000X | Internal Medicine Physician | — | NULL | — |
| 207R00000X | Internal Medicine Physician | — | — | — |
| 363LP2300X | Primary Care Nurse Practitioner | — | NULL | — |
| 363LP2300X | Primary Care Nurse Practitioner | — | — | — |

## Other

- **Enumeration date:** 06/06/2019
- **Last updated:** 06/06/2019

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 56545-1730570136 | — | NC |