Healthcare Provider Details

I. General information

NPI: 1316135585
Provider Name (Legal Business Name): AMOL SOIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/11/2007
Last Update Date: 12/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7076 CORPORATE WAY SUITE 201
DAYTON OH
45459-4281
US

IV. Provider business mailing address

7076 CORPORATE WAY SUITE 201
DAYTON OH
45459-4281
US

V. Phone/Fax

Practice location:
  • Phone: 937-434-2226
  • Fax: 937-434-2283
Mailing address:
  • Phone: 937-434-2226
  • Fax: 937-434-2283

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number35090518
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number35090518
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number35.090518
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: