Provider Demographics
NPI:1215902127
Name:IMM, AMY A (MD)
Entity type:Individual
Prefix:DR
First Name:AMY
Middle Name:A
Last Name:IMM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3555 OLENTANGY RIVER RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43214-3907
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3555 OLENTANGY RIVER RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-3907
Practice Address - Country:US
Practice Address - Phone:614-566-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2009-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-05-8872-I207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH4880094OtherUNITED HEALTHCARE
OH1752330-001OtherCIGNA
OH0674462Medicaid
OH3111906786216OtherBC/BS
OH0757186Medicaid
OH028217300OtherFEDERAL BLACK LUNG
OH2966405837-00OtherBUR OF WORKERS' COMP
OH000000014127OtherANTHEM
OHIM0771262Medicare ID - Type UnspecifiedMEDICARE PROVIDER
OHF17637Medicare UPIN
OH028217300OtherFEDERAL BLACK LUNG
OH2966405837-00OtherBUR OF WORKERS' COMP
OH0757186Medicaid