MEDICARE: DELAWARE INSTITUTE OF PAIN MANAGEMENT &ANTI AGING MEDICINE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207LP2900X	Pain Medicine (Anesthesiology) Physician	C1-0005695	DE

General Provider Information

NPI Number	:	1316032550
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DELAWARE INSTITUTE OF PAIN MANAGEMENT &ANTI AGING MEDICINE LLC

Provider Business Mailing Address
First Line	:	6 E CAMDEN WYOMING AVE
Second Line	:
City	:	CAMDEN
State	:	DE
Zip	:	19934-1301
Country	:	US
Telephone Number	:	302-698-3994
Fax Number	:	302-698-3952

Provider Business Practice Location Address
First Line	:	6 E CAMDEN WYOMING AVE
Second Line	:
City	:	CAMDEN
State	:	DE
Zip	:	19934-1301
Country	:	US
Telephone Number	:	302-698-3994
Fax Number	:	302-698-3952

Authorized Official
Title or Position	:	OWNER/MEDICAL DIRECTOR
Name	:	DR. NAZIM AMEER
Credential	:	M.D
Telephone Number	:	302-359-3974

Provider Enumeration Date	:	10/04/2006
Last Update Date	:	11/27/2007

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