Provider Demographics
NPI:1104892249
Name:AMIN, CHETAN N (DO)
Entity type:Individual
Prefix:DR
First Name:CHETAN
Middle Name:N
Last Name:AMIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 W INNES ST STE B
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:NC
Mailing Address - Zip Code:28144-2575
Mailing Address - Country:US
Mailing Address - Phone:704-636-5626
Mailing Address - Fax:704-636-5641
Practice Address - Street 1:1401 W INNES ST STE B
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28144-2575
Practice Address - Country:US
Practice Address - Phone:704-636-5626
Practice Address - Fax:704-636-5641
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2013-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200000349207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
0143736OtherUHC
NC89127GCMedicaid
NC127GC012MDOtherBCBS
NC2401148AOtherPTAN
0143736OtherUHC