Provider Demographics
NPI:1962762997
Name:MODY, POOJA G (DO)
Entity type:Individual
Prefix:DR
First Name:POOJA
Middle Name:G
Last Name:MODY
Suffix:
Gender:F
Credentials:DO
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Other - First Name:
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Mailing Address - Street 1:6030 S RAINBOW BLVD STE D2
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89118-2548
Mailing Address - Country:US
Mailing Address - Phone:702-329-0229
Mailing Address - Fax:866-611-3024
Practice Address - Street 1:6030 S RAINBOW BLVD STE D2
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89118-2548
Practice Address - Country:US
Practice Address - Phone:702-329-0229
Practice Address - Fax:866-611-3024
Is Sole Proprietor?:No
Enumeration Date:2012-05-24
Last Update Date:2024-07-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NVDO3284208600000X
NY291351-1208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1710607221Medicaid
NV1962762997Medicaid