Provider Demographics
NPI:1003862665
Name:AMUTH, ARAVINDAN (MD)
Entity Type:Individual
Prefix:
First Name:ARAVINDAN
Middle Name:
Last Name:AMUTH
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 1:14 MEMORIAL DR STE B
Mailing Address - Street 2:
Mailing Address - City:DOYLESTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18901-3529
Mailing Address - Country:US
Mailing Address - Phone:215-348-4914
Mailing Address - Fax:
Practice Address - Street 1:14 MEMORIAL DR STE B
Practice Address - Street 2:
Practice Address - City:DOYLESTOWN
Practice Address - State:PA
Practice Address - Zip Code:18901-3529
Practice Address - Country:US
Practice Address - Phone:215-348-4914
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2019-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101265180207Q00000X
NC2018-01263207Q00000X
PAMD425395207Q00000X
DEC1-0007595207Q00000X
FLME90097207Q00000X
GA080351207Q00000X
DCMD045867207Q00000X
SC51900207Q00000X
OH35.132974207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101536563Medicaid
PA096446Medicare ID - Type Unspecified
PAI48405Medicare UPIN