Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 4301101018 | MI |
N | 111NI0900X | Internist | 4301101018 | MI |
Y | 2084N0400X | Neurologist | 2019-01143 | NC |
NPI | 1033466776 |
---|---|
Provider Name | Dr. Sumul Yogeshkumar Modi |
First Address | Charlotte, NC 28275-1803 |
Second Address | Winston Salem, NC 27103 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/08/2012 |
Last Update Date | 26/10/2020 |