Healthcare Provider Details

I. General information

NPI: 1437246287
Provider Name (Legal Business Name): MOHAMMEDYUSUF MODAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: YUSUF MODAN

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2003 S EASTON RD STE 308
DOYLESTOWN PA
18901-7100
US

IV. Provider business mailing address

223 MYSTIC PINE PL
APEX NC
27539-7800
US

V. Phone/Fax

Practice location:
  • Phone: 215-876-5015
  • Fax:
Mailing address:
  • Phone: 215-779-4009
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD436003
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: