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Contact Information

LUCY E MODAHL, MD, PHD
601 FRONT AVENUE
SUITE #502
COEUR D'ALENE, ID83814
 Phone: 208-415-0524
 Fax: 208-763-3644
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Diagnostic Radiology

2085R0202X 30 Physician/Diagnostic Radiology
Indicates primary specialty

NPI Profile & details for LUCY E MODAHL · (Female)

NPI Number 1902868730
Status Active
Credentials MD, PHD
Entity Individual
Enumeration date 04/05/2006
Last updated 05/26/2009 - About 17 years ago
Sole proprietor 1 Yes
Identifiers
  • ID License # M9541
  • KY Medicaid 7100025960
  • PA Medicaid 101968783
  • PA Medicaid 1019687930001
  • VA Medicaid 1902868730
  • KY Other 000000548186 ANTHEM
  • KY Other 50017558 PASSPORT
  • KY Other 3425955000 PASSPORT ADVANTAGE
  • KY Other 91725 SIHO
  • PA Other 2950085 MEDICAL ASSISTANCE NY
  • PA Other 1019687830001 MEDICAL ASSISTANCE PA
  • VA Other 3810010476 MEDICAID WV
  • VA Other P00403958 MEDICARE RAILROAD
Hospital affiliation(s)
  • BAYSTATE FRANKLIN MEDICAL CENTER - (Acute Care)
    164 HIGH STREET
    GREENFIELD, MA 01301
  • BAYSTATE MEDICAL CENTER - (Acute Care)
    759 CHESTNUT STREET
    SPRINGFIELD, MA 01199
  • NOBLE HOSPITAL - (Acute Care)
    115 WEST SILVER STREET
    WESTFIELD, MA 01085
  • NYU HOSPITALS CENTER - (Acute Care)
    550 FIRST AVENUE
    NEW YORK, NY 10016
  • WING MEMORIAL HOSPITAL AND MEDICAL CENTER - (Acute Care)
    40 WRIGHT STREET
    PALMER, MA 01069
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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