Healthcare Provider Details

I. General information

NPI: 1538570163
Provider Name (Legal Business Name): ARVIND MODAWAL MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2014
Last Update Date: 05/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7235 HERITAGESPRING DR
WEST CHESTER OH
45069-6526
US

IV. Provider business mailing address

399 W GALBRAITH RD APT 209
CINCINNATI OH
45215-5035
US

V. Phone/Fax

Practice location:
  • Phone: 513-759-6846
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number35.070118
License Number StateOH

VIII. Authorized Official

Name: ARVIND MODAWAL
Title or Position: PRESIDENT
Credential: MD
Phone: 513-235-2361