Provider Demographics
NPI:1063414217
Name:MODI, KULWANT SINGH (MD,FACP,FASN)
Entity type:Individual
Prefix:DR
First Name:KULWANT
Middle Name:SINGH
Last Name:MODI
Suffix:
Gender:M
Credentials:MD,FACP,FASN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 W BALTIMORE ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21223-1558
Mailing Address - Country:US
Mailing Address - Phone:410-362-3000
Mailing Address - Fax:410-362-3338
Practice Address - Street 1:4310 ENGLISH MORNING LN
Practice Address - Street 2:
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21043-6790
Practice Address - Country:US
Practice Address - Phone:410-418-8740
Practice Address - Fax:410-418-8740
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD 0059917207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD093SMedicare ID - Type Unspecified
MDE51974Medicare UPIN