Individual
MAMATHA MODEM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D
Contact information
Practice address
1400 N WESTMORELAND RD, DALLAS, TX 75211-1656
(214) 266-0500
Mailing address
PO BOX 660599, DALLAS, TX 75266-0599
Taxonomy
Speciality
Code
Description
License number
State
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
E4935
AR
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
Primary
P1902
TX
Other
Enumeration date
08/21/2006
Last updated
03/30/2013
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