Individual
DR. VICKI ELLEN MODEST
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
55 FRUIT ST, CLN 3, BOSTON, MA 02114-2621
(617) 726-3030
(617) 726-7536
Mailing address
PO BOX 9142, MASS GENERAL PHYSICIANS ORGANIZATION, CHARLESTOWN, MA 02129-9142
(617) 724-0287
(617) 726-2894
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
153069
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3162729
—
MA
01
—
766987
TUFTS HEALTH PLAN
MA
01
—
J17346
BCBS MA
MA
Enumeration date
11/16/2005
Last updated
12/14/2011
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