Provider Demographics
NPI:1073578399
Name:AMIN, MAHUL B (MD)
Entity Type:Individual
Prefix:
First Name:MAHUL
Middle Name:B
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 603283
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-3283
Mailing Address - Country:US
Mailing Address - Phone:901-516-7182
Mailing Address - Fax:901-276-5474
Practice Address - Street 1:1265 UNION AVE
Practice Address - Street 2:DEPT OF PATHOLOGY, 6 SHERARD
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-3415
Practice Address - Country:US
Practice Address - Phone:901-516-7182
Practice Address - Fax:901-276-5474
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2016-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC52183174400000X
TN55160207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No174400000XOther Service ProvidersSpecialist