Healthcare Provider Details

I. General information

NPI: 1104881101
Provider Name (Legal Business Name): MOHAMMAD BASIL AMIN M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2006
Last Update Date: 05/28/2025
Certification Date: 05/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

142 WOODRIDGE RD
BERLIN VT
05602-9165
US

IV. Provider business mailing address

PO BOX 2468
PALATKA FL
32177
US

V. Phone/Fax

Practice location:
  • Phone: 802-371-4700
  • Fax:
Mailing address:
  • Phone: 386-325-8482
  • Fax: 386-325-3512

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number042.0014077
License Number StateVT
# 2
Primary TaxonomyN
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License NumberME0072588
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: