Provider Demographics
NPI:1528178076
Name:MODI MEDICAL CORPORATION
Entity type:Organization
Organization Name:MODI MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JIGNESH
Authorized Official - Middle Name:J
Authorized Official - Last Name:MODI
Authorized Official - Suffix:
Authorized Official - Credentials:MD PA
Authorized Official - Phone:304-204-2430
Mailing Address - Street 1:40 FAIRLAND DRIVE
Mailing Address - Street 2:
Mailing Address - City:NITRO
Mailing Address - State:WV
Mailing Address - Zip Code:25143
Mailing Address - Country:US
Mailing Address - Phone:304-204-2430
Mailing Address - Fax:304-397-6740
Practice Address - Street 1:4605 MACCORKLE AVE SW STE 302
Practice Address - Street 2:
Practice Address - City:SOUTH CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25309-1311
Practice Address - Country:US
Practice Address - Phone:304-204-2430
Practice Address - Fax:304-397-6740
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2017-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV19795207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
9341491OtherPTAN
WV0300025000Medicaid
JI0875181Medicare PIN
9341491Medicare ID - Type UnspecifiedGROUP
9341491OtherPTAN