Basic Information
| Provider Information | |||||||||
| NPI: | 1437680329 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MODI | ||||||||
| FirstName: | SHAN | ||||||||
| MiddleName: | PARESH | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3600 FORBES AVENUE | ||||||||
| Address2: | FORBES TOWER- PLAZA LEVEL SUITE 140 | ||||||||
| City: | PITTSBURGH | ||||||||
| State: | PA | ||||||||
| PostalCode: | 15213 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5135588114 | ||||||||
| FaxNumber: | 5135585791 | ||||||||
| Practice Location | |||||||||
| Address1: | 3550 TERRACE ST | ||||||||
| Address2: | SCAIFE HALL, ROOM 651 | ||||||||
| City: | PITTSBURGH | ||||||||
| State: | PA | ||||||||
| PostalCode: | 15261 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4126473136 | ||||||||
| FaxNumber: | 5135585791 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/23/2017 | ||||||||
| LastUpdateDate: | 07/15/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/15/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207P00000X | 35.139518 | OH | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.