Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RN0300X | Nephrologist | D 0059917 | MD |
NPI | 1063414217 |
---|---|
Provider Name | Dr. Kulwant Singh Modi |
First Address | Baltimore, MD 21223-1558 |
Second Address | Ellicott City, MD 21043-6790 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/06/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E51974 | (02) | MD |