MEDICARE: DR. DANIEL CHRISTOPHER MODARELLI DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	34-006969	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	264200000	OTHER	OH	FEDERAL BLACK LUNG
2	000000339418	OTHER	OH	ANTHEM
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	6600162	OTHER	OH	UNITED HEALTHCARE
5	264200000	OTHER	OH	DEPT OF LABOR
6	80507	OTHER	OH	QUALCHOICE

General Provider Information

NPI Number	:	1033179791
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DANIEL CHRISTOPHER MODARELLI DO

Provider Business Mailing Address
First Line	:	7580 AUBURN ROAD
Second Line	:	SUITE 202
City	:	CONCORD TWP
State	:	OH
Zip	:	44077-9406
Country	:	US
Telephone Number	:	440-352-0400
Fax Number	:	440-352-4535

Provider Business Practice Location Address
First Line	:	7580 AUBURN ROAD
Second Line	:	SUITE 202
City	:	CONCORD TWP
State	:	OH
Zip	:	44077-9406
Country	:	US
Telephone Number	:	440-352-0400
Fax Number	:	440-352-4535

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/27/2006
Last Update Date	:	02/25/2021

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