Provider Demographics
NPI:1760452973
Name:AMIN, DEVENDRA KANAIYALAL (MD)
Entity Type:Individual
Prefix:DR
First Name:DEVENDRA
Middle Name:KANAIYALAL
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 1:3735 NAZARETH RD
Mailing Address - Street 2:STE 302
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18045-8338
Mailing Address - Country:US
Mailing Address - Phone:610-258-2588
Mailing Address - Fax:610-252-7951
Practice Address - Street 1:3735 EASTON NAZARETH RD
Practice Address - Street 2:SUITE 302
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18045
Practice Address - Country:US
Practice Address - Phone:610-258-2588
Practice Address - Fax:610-258-3946
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2011-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05883400174400000X
PAMD038845E174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6018904Medicaid
PA0014381760001Medicaid
B50330Medicare UPIN
NJ072820Medicare PIN
PA0014381760001Medicaid