Physician Compare National (NPI:1447274840)

HEALTHCARE PROVIDER: DR. CHARLOTTE ELISABETH MODLY

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1447274840
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	2860568789
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20080829000111
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	MODLY
	Individual professional last name
Provider First Name	CHARLOTTE
	Individual professional first name
Provider Middle Name	E
	Individual professional middle name
Provider Gender	F
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	CLVLND CLINIC LERNER COLLEGE OF MED OF CASE WSTN RSV UNIVERSITY
	Individual professional's medical school
Graduation Year	1981
	Individual professional's medical school graduation year
Primary Specialty	DERMATOLOGY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	4 GLYNDON DR
	Group Practice or individual's line 1 address
Line 2 Street Address	2G
	Group Practice or individual's line 2 address
City	REISTERSTOWN
	Group Practice or individual's city
State	MD
	Group Practice or individual's state
Zip Code	211362002
	Group Practice or individual's zip code (9 digits when available)
Phone Number	4105261300
	Phone number is listed only when there is a single phone number available for the practice location address

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	Y