Individual
ANTHONY L MODICA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1514 JEFFERSON HWY, NEW ORLEANS, LA 70121-2429
(504) 842-3470
(540) 891-5769
Mailing address
1514 JEFFERSON HWY, NEW ORLEANS, LA 70121-2429
(504) 842-4000
(540) 891-5769
Taxonomy
Speciality
Code
Description
License number
State
2085P0229X
Pediatric Radiology Physician
MD.08792R
LA
2085R0202X
Diagnostic Radiology Physician
D0050358
MD
2085R0202X
Diagnostic Radiology Physician
Primary
MD.08792R
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
07828361
—
MS
05
—
205744100
—
MD
05
—
2347241
—
LA
01
—
60234801
BLUE SHIELD
MD
01
—
80430028
BLUE SHIELD
DC
Enumeration date
07/28/2006
Last updated
09/25/2024
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