Provider Demographics
NPI:1518489996
Name:AMAN DEEP, FNU (MD)
Entity Type:Individual
Prefix:
First Name:FNU
Middle Name:
Last Name:AMAN DEEP
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 1:760 GOLF VIEW DR UNIT 200
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-9685
Mailing Address - Country:US
Mailing Address - Phone:541-842-9446
Mailing Address - Fax:617-506-2110
Practice Address - Street 1:760 GOLF VIEW DR UNIT 200
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-9685
Practice Address - Country:US
Practice Address - Phone:541-842-9446
Practice Address - Fax:617-506-2110
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-07
Last Update Date:2022-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA272102207R00000X
ORMD208412174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine