Provider Demographics
NPI:1356561179
Name:MODI, ISHA TRUPEN (PA)
Entity type:Individual
Prefix:
First Name:ISHA
Middle Name:TRUPEN
Last Name:MODI
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Gender:F
Credentials:PA
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Mailing Address - Street 1:1015 W BALTIMORE PIKE
Mailing Address - Street 2:JENNERSVILLE REGIONAL HOSPITAL
Mailing Address - City:WEST GROVE
Mailing Address - State:PA
Mailing Address - Zip Code:19390-9459
Mailing Address - Country:US
Mailing Address - Phone:610-869-1000
Mailing Address - Fax:610-617-6280
Practice Address - Street 1:1015 W BALTIMORE PIKE
Practice Address - Street 2:JENNERSVILLE REGIONAL HOSPITAL
Practice Address - City:WEST GROVE
Practice Address - State:PA
Practice Address - Zip Code:19390-9459
Practice Address - Country:US
Practice Address - Phone:610-869-1000
Practice Address - Fax:610-617-6280
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
PAMA052926363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant