Provider Demographics
NPI:1932362985
Name:ETMAN, AMR (MD)
Entity type:Individual
Prefix:
First Name:AMR
Middle Name:
Last Name:ETMAN
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 1:18901 NORTHERN BLVD
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11358-2824
Mailing Address - Country:US
Mailing Address - Phone:917-410-6905
Mailing Address - Fax:646-878-6095
Practice Address - Street 1:18901 NORTHERN BLVD
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11358-2824
Practice Address - Country:US
Practice Address - Phone:917-410-6905
Practice Address - Fax:646-878-6095
Is Sole Proprietor?:No
Enumeration Date:2008-07-09
Last Update Date:2024-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY8029A207V00000X
VA0101257200207VG0400X
NY275480-01207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0101257200OtherLICENSE
WY8029AOtherWYOMING LICENSE#
WY307009OtherCHWHC MEDICARE
WY830306180OtherTAX ID
WY124781600Medicaid