# MODERN MEDICINE INC

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

## Provider details

- **NPI number:** 1942256821
- **Authorized official:** ELIAS HAIKAL MD (PRESIDENT)
- **Authorized official phone:** (304) 755-0119

## Contact information

- **Practice address:** 4114 1ST AVE, NITRO, WV 25143
- **Practice address phone:** (304) 755-0119
- **Practice address fax:** (304) 755-0111
- **Mailing address:** 4114 1ST AVE, NITRO, WV 25143-1304
- **Mailing address phone:** (304) 755-0119
- **Mailing address fax:** (304) 755-0111

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 1111 | WV | Yes |
| 332B00000X | Durable Medical Equipment & Medical Supplies | 11111 | WV | — |

## Other

- **Enumeration date:** 05/25/2006
- **Last updated:** 04/19/2012