Provider Demographics
NPI:1316907892
Name:MODY, HARSHAD R (MD)
Entity type:Individual
Prefix:DR
First Name:HARSHAD
Middle Name:R
Last Name:MODY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:7310 RITCHIE HWY
Mailing Address - Street 2:SUITE 710
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061-3065
Mailing Address - Country:US
Mailing Address - Phone:410-760-5599
Mailing Address - Fax:410-760-3917
Practice Address - Street 1:7310 RITCHIE HWY
Practice Address - Street 2:SUITE 710
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-3065
Practice Address - Country:US
Practice Address - Phone:410-760-5599
Practice Address - Fax:410-760-3917
Is Sole Proprietor?:No
Enumeration Date:2006-03-27
Last Update Date:2012-10-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD00236322084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD779301400Medicaid
MDKM19Medicare ID - Type UnspecifiedPRACTICE ID NUMBER
MD779301400Medicaid