Individual
LYLE TERRENCE MODLIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.P.M.
Contact information
Practice address
43 OLD SOLOMONS ISLAND RD, SUITE 102, ANNAPOLIS, MD 21401-3850
(410) 263-3100
(410) 263-7380
Mailing address
43 OLD SOLOMONS ISLAND RD, SUITE 102, ANNAPOLIS, MD 21401-3850
(410) 263-3100
(410) 263-7380
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
00631
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4081901
—
MD
05
—
463068800
—
MD
Enumeration date
07/31/2006
Last updated
04/22/2014
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