MEDICARE: DR. SANJAY M AMIN M.D.

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	173000000X	Legal Medicine	0101030736	VA

General Provider Information

NPI Number	:	1912904525
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SANJAY M AMIN M.D.

Provider Business Mailing Address
First Line	:	228 MARSH ISLAND DR
Second Line	:
City	:	CHESAPEAKE
State	:	VA
Zip	:	23320-9246
Country	:	US
Telephone Number	:	757-627-3454
Fax Number	:

Provider Business Practice Location Address
First Line	:	1529 INTERNATIONAL BLVD
Second Line	:	SUITE 103
City	:	NORFOLK
State	:	VA
Zip	:	23513-4802
Country	:	US
Telephone Number	:	757-855-6800
Fax Number	:	757-855-7771

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/29/2005
Last Update Date	:	07/08/2007

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