Individual
MR. TROY G MODISETTE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PMHNP
Contact information
Practice address
2401 W BELVEDERE AVE, BALTIMORE, MD 21215-5216
(410) 601-1000
Mailing address
10601 VIRGINIA AVE, COCKEYSVILLE, MD 21030-2315
(443) 742-9167
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
R148972
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
R148972
NURSE PRACTITIONER
MD
Enumeration date
10/20/2019
Last updated
10/31/2020
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