Provider Demographics
NPI:1366464497
Name:AMIN, VIMAL P (MD)
Entity Type:Individual
Prefix:DR
First Name:VIMAL
Middle Name:P
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 1:108 HEALTHCARE DR
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:SC
Mailing Address - Zip Code:29720-8037
Mailing Address - Country:US
Mailing Address - Phone:803-286-9963
Mailing Address - Fax:803-283-6330
Practice Address - Street 1:108 HEALTHCARE DR
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:SC
Practice Address - Zip Code:29720-8037
Practice Address - Country:US
Practice Address - Phone:803-286-9963
Practice Address - Fax:803-283-6330
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2013-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC20952207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP2815Medicaid
SCG39330Medicare UPIN
SCGP2815Medicaid