Basic Information
| Provider Information | |||||||||
| NPI: | 1932405479 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MODY | ||||||||
| FirstName: | NEHA | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | P.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 800 WALNUT ST | ||||||||
| Address2: | 9TH FL | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191045176 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2158298713 | ||||||||
| FaxNumber: | 2158295350 | ||||||||
| Practice Location | |||||||||
| Address1: | 800 WALNUT ST FL 9 | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191075176 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2158298713 | ||||||||
| FaxNumber: | 2158295350 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/01/2011 | ||||||||
| LastUpdateDate: | 11/08/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AS0400X | MA059320 | PA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical | 363A00000X | 0110003490 | VA | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.