Doctor Name: | DR. JAYSHRI M MODY |
NPI Number: | 1639283450 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MD |
License Number: | 13069 |
Business Practice Address: | 5600 Us Route 60 Huntington, WV - 257052146 |
Business Phone Number: | 3045257851 |
Business Fax Number: | 3045251073 |
Mailing Address: | 3375 Us Route 60, HUNTINGTON |
State: | WV |
Postal Code: | 257052837 |
Phone Number: | 3045257851 |
Fax Number: | 3045251073 |
NPI Enumeration Date: | 08/18/2006 |
NPI Last Update Date: | 03/01/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | 13069 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WV |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |