Provider Demographics
NPI:1336285626
Name:DORN, AMANDA STINE (MD)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:STINE
Last Name:DORN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 EUROPA DRIVE
Mailing Address - Street 2:SUITE 170
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27517
Mailing Address - Country:US
Mailing Address - Phone:919-928-0144
Mailing Address - Fax:919-928-0145
Practice Address - Street 1:101 EUROPA DRIVE
Practice Address - Street 2:SUITE 170
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27517
Practice Address - Country:US
Practice Address - Phone:919-928-0144
Practice Address - Fax:919-928-0145
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2000023925592084P0800X
NC2009-008172084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDT1782OtherID