Provider Demographics
NPI:1356658389
Name:AMARA, ASHVIN (MD)
Entity Type:Individual
Prefix:
First Name:ASHVIN
Middle Name:
Last Name:AMARA
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 1:6429 BANNINGTON RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28226-1344
Mailing Address - Country:US
Mailing Address - Phone:704-503-9338
Mailing Address - Fax:704-503-9339
Practice Address - Street 1:6429 BANNINGTON RD STE B
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28226-1345
Practice Address - Country:US
Practice Address - Phone:704-503-9338
Practice Address - Fax:704-503-9339
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-13
Last Update Date:2015-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2011-01487207LP2900X, 207LP2900X
SC33814207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine