NPI 1417110461 · live from the CMS NPI Registry
Tejal Mody, M.D.
Radiology, Pediatric Radiology in Glen Mills, PA. National Provider Identifier 1417110461, active.
NPI record
| NPI | 1417110461 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Radiology, Pediatric Radiology 2085P0229X |
| Practice location | 101 Applied Bank Blvd Ste 11, Nemours Dupont Pediatrics, Glen Mills, Glen Mills, PA 19342 |
| Practice phone | 484-800-8630 |
| Mailing address | Po Box 191, Provider Enrollment Department, Rockland, DE 19732 |
| Enumerated | July 9, 2008 |
| Last updated | February 23, 2017 |
| Sole proprietor | No |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Radiology, Diagnostic Radiology | 2085R0202X | P7163 (TX) |
| Radiology, Diagnostic Radiology | 2085R0202X | ME118748 (FL) |
| Radiology, Pediatric Radiology primary | 2085P0229X | MD459411 (PA) |
| Radiology, Pediatric Radiology | 2085P0229X | 25MA10023300 (NJ) |
| Radiology, Pediatric Radiology | 2085P0229X | C10011787 (DE) |
| Radiology, Pediatric Radiology | 2085P0229X | ME118748 (FL) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.