Provider Demographics
NPI:1992813224
Name:MODICA, JOHN (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:MODICA
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:320 POMFRET ST
Mailing Address - Street 2:DAY KIMBALL HOSPITAL
Mailing Address - City:PUTNAM
Mailing Address - State:CT
Mailing Address - Zip Code:06260
Mailing Address - Country:US
Mailing Address - Phone:860-481-3730
Mailing Address - Fax:442-268-1928
Practice Address - Street 1:320 POMFRET ST
Practice Address - Street 2:DAY KIMBALL HOSPITAL
Practice Address - City:PUTNAM
Practice Address - State:CT
Practice Address - Zip Code:06260
Practice Address - Country:US
Practice Address - Phone:860-481-3730
Practice Address - Fax:442-268-1928
Is Sole Proprietor?:No
Enumeration Date:2006-08-28
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT26506CT207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
E42827Medicare UPIN