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General NPI Number Information
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NPI Number | 1871868646
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Entity Type | Individual
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Provider Name | PUJA MODY PA-C
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Gender | Female
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Dates
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Enumeration Date | 03/13/2012
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Last Update Date | 08/31/2021
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Provider Practice Location Address
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Address Line | 900 S CATON AVE
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City | BALTIMORE
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State | MD
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Zip | 21229-5201
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Country | US
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Telephone | 410-368-6000
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Fax |
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Provider Business Mailing Address
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Address Line | 3035 E BALTIMORE ST
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City | BALTIMORE
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State | MD
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Zip | 21224-1349
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Country | US
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Telephone | 540-529-6721
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Fax |
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 0110003756
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | C0004721
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License Number State | MD
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