Organization
MODI MEDICAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JIGNESH J MODI MD PA (PRESIDENT)
(304) 204-2430
Entity
Organization
Contact information
Practice address
4605 MACCORKLE AVE SW STE 302, SOUTH CHARLESTON, WV 25309-1311
(304) 204-2430
(304) 397-6740
Mailing address
40 FAIRLAND DRIVE, NITRO, WV 25143
(304) 204-2430
(304) 397-6740
Taxonomy
Speciality
Code
Description
License number
State
207RI0200X
Infectious Disease Physician
Primary
19795
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0300025000
—
WV
01
—
9341491
PTAN
—
Enumeration date
08/30/2006
Last updated
10/20/2017
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