Individual
VIRAJ INDRAVADAN MODI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
UCONN MEDICAL GROUP, 263 FARMINGTON AVENUE, FARMINGTON, CT 06030-0001
(860) 679-4477
(860) 679-4474
Mailing address
UCONN MEDICAL GROUP, 263 FARMINGTON AVENUE, FARMINGTON, CT 06030-0001
(860) 679-4477
(860) 679-4474
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
55017
CT
207R00000X
Internal Medicine Physician
OS12190
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
012203500
—
FL
01
—
14V1L
BLUE CROSS BLUE SHIELD
FL
Enumeration date
03/19/2011
Last updated
09/29/2022
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