Provider Demographics
NPI:1386600112
Name:BELL, AMANDA (MD)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:BELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:
Other - Last Name:LIGGETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2365 LAKEVIEW DR
Mailing Address - Street 2:STE C
Mailing Address - City:BEAVERCREEK
Mailing Address - State:OH
Mailing Address - Zip Code:45431-4600
Mailing Address - Country:US
Mailing Address - Phone:937-705-6287
Mailing Address - Fax:937-912-9595
Practice Address - Street 1:2365 LAKEVIEW DR
Practice Address - Street 2:STE C
Practice Address - City:BEAVERCREEK
Practice Address - State:OH
Practice Address - Zip Code:45431-4600
Practice Address - Country:US
Practice Address - Phone:937-705-6287
Practice Address - Fax:937-912-9595
Is Sole Proprietor?:No
Enumeration Date:2006-04-21
Last Update Date:2015-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35075095207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2079290Medicaid
G87664Medicare UPIN
OH2079290Medicaid