Provider Demographics
NPI:1427073774
Name:AMIN, ALI (MD)
Entity type:Individual
Prefix:DR
First Name:ALI
Middle Name:
Last Name:AMIN
Suffix:
Gender:M
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:PO BOX 4985
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17604-4985
Mailing Address - Country:US
Mailing Address - Phone:717-391-7092
Mailing Address - Fax:
Practice Address - Street 1:2494 BERNVILLE RD STE 203
Practice Address - Street 2:
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19605-9467
Practice Address - Country:US
Practice Address - Phone:610-378-2499
Practice Address - Fax:610-378-2989
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2020-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD045969L2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001531484Medicaid
PAG09235Medicare UPIN
PA785226Medicare PIN