Provider Demographics
NPI:1487745022
Name:MODY, HIREN (MD)
Entity type:Individual
Prefix:
First Name:HIREN
Middle Name:
Last Name:MODY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 SHELBURNE RD
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06902-3628
Mailing Address - Country:US
Mailing Address - Phone:230-276-7298
Mailing Address - Fax:
Practice Address - Street 1:30 SHELBURNE RD
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06902-3628
Practice Address - Country:US
Practice Address - Phone:203-276-7010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT041508207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT9721521OtherCIGNA
CT010041508CT01OtherANTHEM
CTP3151623OtherOXFORD
CT041508OtherCCI
CT3308340OtherAETNA - HMO
CTP00111131OtherRR MEDICARE
CT7043515OtherAETNA - PPO
CT2V4055OtherHEALTH NET
TINOtherUNITED
CT90S67OtherEMPIRE BC/BS
CT041508OtherCCI