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General NPI Number Information
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NPI Number | 1104881101
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Entity Type | Individual
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Provider Name | MOHAMMAD BASIL AMIN M.D
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Gender | Male
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Dates
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Enumeration Date | 04/20/2006
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Last Update Date | 05/28/2025
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Provider Practice Location Address
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Address Line | 142 WOODRIDGE RD
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City | BERLIN
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State | VT
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Zip | 05602-9165
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Country | US
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Telephone | 802-371-4700
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2468
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City | PALATKA
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State | FL
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Zip | 32177
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Country | US
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Telephone | 386-325-8482
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Fax | 386-325-3512
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RA0401X
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Taxonomy Name | Addiction Medicine (Internal Medicine) Physician
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License Number | ME0072588
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 042.0014077
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License Number State | VT
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