Charlotte Elisabeth Modly

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

D43457 Issued in MD

Practice address

4 Glyndon Dr
Suite 2G
Reisterstown, MD 21136-2000

Phone

(410) 526-1300

Fax

(410) 526-3316

NPI assigned

Jul 27, 2006

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MD

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Dermatology

Education

Clvlnd Clinic Lerner College of Med of Case WSTN RSV University, 1981

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Epiphany Dermatology of Maryland, PAGroup PAC ID 8426047770, 12 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

23.63 of 100Reported as individual

Quality

0

Improvement activities

0

Cost

78.75

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: charlotte.modly@epiphanyderm.emadirect.md

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Epiphany Dermatology of Maryland PA

  dba Epiphany Dermatology

  • Dermatology Physician
  • Bethesda, MD
  • NPI 1679521165
  Medicare reassignment Care Compare group NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1153958400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1447274840",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4 GLYNDON DR",
            "address_2": "SUITE 2G",
            "city": "REISTERSTOWN",
            "state": "MD",
            "postal_code": "211362000",
            "telephone_number": "410-526-1300",
            "fax_number": "410-526-3316"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4 GLYNDON DR",
            "address_2": "SUITE 2G",
            "city": "REISTERSTOWN",
            "state": "MD",
            "postal_code": "211362000",
            "telephone_number": "410-526-1300",
            "fax_number": "410-526-3316"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MODLY",
        "first_name": "CHARLOTTE",
        "middle_name": "ELISABETH",
        "name_prefix": "Dr.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-07-27",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "MD",
            "license": "D43457",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mindfull Newtrition LLC
• Mindfull Newtrition LLC
• Judah Minkove, M.D.
• Karen L Minor, CRNP
• Mobile Eyewear Services LLC
• Mon's Homecare LLC
• Scott D. Morsberger, PA-C
• Robert Leslie Moss, MD
• Sahel Kargar Mount, FNP-C
• Shehzin Mozammel Palad, MS, CRNA

• Dermatology Physician in Reisterstown, MD
• Providers in Reisterstown, MD by specialty
• Dermatology Physician in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.