Provider Demographics
NPI:1861424772
Name:MODI, MIHIR GOVIND (DO)
Entity type:Individual
Prefix:DR
First Name:MIHIR
Middle Name:GOVIND
Last Name:MODI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3421 CONCORD RD
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-9001
Mailing Address - Country:US
Mailing Address - Phone:717-851-1300
Mailing Address - Fax:717-851-1310
Practice Address - Street 1:755 S PLEASANT AVE
Practice Address - Street 2:
Practice Address - City:DALLASTOWN
Practice Address - State:PA
Practice Address - Zip Code:17313-9252
Practice Address - Country:US
Practice Address - Phone:717-851-1300
Practice Address - Fax:717-851-1310
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2014-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS011244207Q00000X
OH34007081207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD611872OtherCAREFIRST MD BCBS
PA120188OtherUNISON-WMG
PA1310724OtherHIGHMARK BLUE SHIELD
PA294503OtherMAMSI-WMG
PA12463OtherJOHNS HOPKINS
PAP002839OtherGATEWAY-WMG
PA001859623Medicaid
PA0194610000OtherAMERIHEALTH 65 PA
PA20005318OtherAMERIHEALTH MERCY-WMG
PA01069203OtherCAPITAL BLUE CROSS-WMG
PA100461OtherGEISINGER
PA7336508OtherAETNA
PA294503OtherMAMSI-WMG
PA051739FLTMedicare PIN
PA12463OtherJOHNS HOPKINS