Provider Demographics
NPI:1285816322
Name:NTATIN, AMUSA N (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:AMUSA
Middle Name:N
Last Name:NTATIN
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9606 FABLE DR
Mailing Address - Street 2:
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-4795
Mailing Address - Country:US
Mailing Address - Phone:319-486-1585
Mailing Address - Fax:
Practice Address - Street 1:9606 FABLE DR
Practice Address - Street 2:
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117-4795
Practice Address - Country:US
Practice Address - Phone:319-486-1585
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-30
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD434844208M00000X
NC2009-01061208M00000X
OH096087208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3123337Medicaid
OHH026683Medicare PIN
OH3123337Medicaid