Healthcare Provider Details

I. General information

NPI: 1912904525
Provider Name (Legal Business Name): SANJAY M AMIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1529 INTERNATIONAL BLVD SUITE 103
NORFOLK VA
23513-4802
US

IV. Provider business mailing address

228 MARSH ISLAND DR
CHESAPEAKE VA
23320-9246
US

V. Phone/Fax

Practice location:
  • Phone: 757-855-6800
  • Fax: 757-855-7771
Mailing address:
  • Phone: 757-627-3454
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number0101030736
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: