Healthcare Provider Details

I. General information

NPI: 1912361643
Provider Name (Legal Business Name): AMIN K. SOLTANI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2016
Last Update Date: 01/11/2023
Certification Date: 01/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 ERDMAN WAY
LEOMINSTER MA
01453-1852
US

IV. Provider business mailing address

105 ERDMAN WAY
LEOMINSTER MA
01453-1852
US

V. Phone/Fax

Practice location:
  • Phone: 978-537-7552
  • Fax: 978-537-7383
Mailing address:
  • Phone: 978-537-7552
  • Fax: 978-537-7383

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number282975
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: