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1083961072 NPI number — PAYAL URVIJ MODHIA M.D.

NPI Number: 1083961072
Health Care Provider/Practitioner: PAYAL URVIJ MODHIA M.D.

Information about “1083961072” NPI (PAYAL URVIJ MODHIA M.D.) exists in 1083961072 in HTML format HTML  |  1083961072 in plain Text format TXT  |  1083961072 in PDF (Portable Document Format) PDF  |  1083961072 in an XML format XML  formats.

NPI Number : 1083961072 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1083961072",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "MODHIA",
    "FirstName": "PAYAL",
    "MiddleName": "URVIJ",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "M.D.",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "PO BOX 26666",
    "SecondLineMailingAddress": "PHS PROVIDER ENROLLMENT",
    "MailingAddressCityName": "ALBUQUERQUE",
    "MailingAddressStateName": "NM",
    "MailingAddressPostalCode": "87125-6666",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "505-923-6770",
    "MailingAddressFaxNumber": "505-923-5354",
    "FirstLinePracticeLocationAddress": "1100 CENTRAL AVE SE FL 4",
    "SecondLinePracticeLocationAddress": "PMG HOSPITALIST",
    "PracticeLocationAddressCityName": "ALBUQUERQUE",
    "PracticeLocationAddressStateName": "NM",
    "PracticeLocationAddressPostalCode": "87106-4930",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "505-724-6124",
    "PracticeLocationAddressFaxNumber": "505-724-6125",
    "EnumerationDate": "08/08/2012",
    "LastUpdateDate": "02/03/2024",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "208M00000X",
          "TaxonomyName": "Hospitalist Physician",
          "LicenseNumber": "MD2014-0753",
          "LicenseNumberStateCode": "NM",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "207R00000X",
          "TaxonomyName": "Internal Medicine Physician",
          "LicenseNumber": "125061482",
          "LicenseNumberStateCode": "IL",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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