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General NPI Number Information
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NPI Number | 1851451702
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Entity Type | Individual
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Provider Name | BHARAT M MODY MD
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Gender | Male
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Dates
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Enumeration Date | 12/11/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 201 PROFESSIONAL PARK
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City | GLASGOW
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State | KY
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Zip | 42141
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Country | US
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Telephone | 270-651-8789
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Fax | 270-651-1126
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Provider Business Mailing Address
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Address Line | PO BOX 308
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City | GLASGOW
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State | KY
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Zip | 42142-0308
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Country | US
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Telephone | 270-651-8789
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Fax | 270-651-1126
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 18483
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License Number State | KY
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