Provider Demographics
NPI:1487968970
Name:BARBARA M MODIC MD INC
Entity type:Organization
Organization Name:BARBARA M MODIC MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:MODIC
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-792-2577
Mailing Address - Street 1:25 N CANFIELD NILES RD
Mailing Address - Street 2:SUITE110
Mailing Address - City:AUSTINTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44515-2328
Mailing Address - Country:US
Mailing Address - Phone:330-792-2577
Mailing Address - Fax:330-792-3199
Practice Address - Street 1:25 N CANFIELD NILES RD
Practice Address - Street 2:SUITE110
Practice Address - City:AUSTINTOWN
Practice Address - State:OH
Practice Address - Zip Code:44515-2328
Practice Address - Country:US
Practice Address - Phone:330-792-2577
Practice Address - Fax:330-792-3199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-27
Last Update Date:2010-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35055600302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization