Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RI0200X | Infectious Disease | 35.126560 | OH |
NPI | 1063556074 |
---|---|
Provider Name | Jignesh Jashawant Modi |
First Address | Nitro, WV 25143-1186 |
Second Address | Zanesville, OH 43701-1880 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/02/2007 |
Last Update Date | 14/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G91768 | (02) | WV |