Individual
INGRID E MODY
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
267 GRANT ST, BRIDGEPORT, CT 06610-2805
(203) 384-3873
(203) 384-3829
Mailing address
PO BOX 5246, BRIDGEPORT, CT 06610-0246
(203) 384-3873
(203) 384-3829
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
000973
CT
Other
Enumeration date
04/20/2006
Last updated
07/08/2007
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