Provider Demographics
NPI:1376541318
Name:AMINI, DENNIS
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:
Last Name:AMINI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2101 E JEFFERSON ST
Mailing Address - Street 2:KAISER PERMANENTE MEDICARE ENROLLMENT
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-4908
Mailing Address - Country:US
Mailing Address - Phone:301-816-2424
Mailing Address - Fax:
Practice Address - Street 1:5100 AUTH WAY
Practice Address - Street 2:MARLOW HEIGHTS MEDICAL CENTER
Practice Address - City:SUITLAND
Practice Address - State:MD
Practice Address - Zip Code:20746-4207
Practice Address - Country:US
Practice Address - Phone:301-702-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC34029207V00000X
DCMD34029207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00036533OtherMEDICARE RAILROAD
VA010003466Medicaid
DC034868400Medicaid
MD402226200Medicaid
DC012135G65Medicare PIN
P00036533OtherMEDICARE RAILROAD