Provider Demographics
NPI:1215314521
Name:SEN, AMANDA LUTTER (DPM)
Entity type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:LUTTER
Last Name:SEN
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:426 BEECHER RD STE A
Mailing Address - Street 2:
Mailing Address - City:GAHANNA
Mailing Address - State:OH
Mailing Address - Zip Code:43230-3506
Mailing Address - Country:US
Mailing Address - Phone:614-939-9330
Mailing Address - Fax:614-939-9299
Practice Address - Street 1:426 BEECHER RD STE A
Practice Address - Street 2:
Practice Address - City:GAHANNA
Practice Address - State:OH
Practice Address - Zip Code:43230-3506
Practice Address - Country:US
Practice Address - Phone:614-939-9330
Practice Address - Fax:614-939-9299
Is Sole Proprietor?:No
Enumeration Date:2015-05-06
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0103301259213ES0103X
IN07001274A213ES0103X
KY00488213ES0103X
OH390200000X
OH36003891213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHFL0291740OtherDEA