Provider Demographics
NPI:1720013733
Name:SHIRISH A. AMIN M.D., P.C.
Entity Type:Organization
Organization Name:SHIRISH A. AMIN M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:SHIRISH
Authorized Official - Middle Name:A
Authorized Official - Last Name:AMIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:724-465-6650
Mailing Address - Street 1:1265 WAYNE AVE
Mailing Address - Street 2:119 PROFESSIONAL CENTER SUITE 301
Mailing Address - City:INDIANA
Mailing Address - State:PA
Mailing Address - Zip Code:15701-3501
Mailing Address - Country:US
Mailing Address - Phone:724-465-6650
Mailing Address - Fax:724-357-9281
Practice Address - Street 1:1265 WAYNE AVE
Practice Address - Street 2:119 PROFESSIONAL CENTER SUITE 301
Practice Address - City:INDIANA
Practice Address - State:PA
Practice Address - Zip Code:15701-3501
Practice Address - Country:US
Practice Address - Phone:724-465-6650
Practice Address - Fax:724-357-9281
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
Last Update Date:2019-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0017069000004Medicaid
PA0017069000004Medicaid
PAG79329Medicare UPIN