Provider Demographics
NPI:1801003157
Name:AMIN, MITESH S (MD)
Entity Type:Individual
Prefix:
First Name:MITESH
Middle Name:S
Last Name:AMIN
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Gender:M
Credentials:MD
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Mailing Address - Street 1:445 CHARLES H DIMMOCK PKWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:COLONIAL HEIGHTS
Mailing Address - State:VA
Mailing Address - Zip Code:23834-2970
Mailing Address - Country:US
Mailing Address - Phone:804-520-1764
Mailing Address - Fax:866-781-3220
Practice Address - Street 1:445 CHARLES H DIMMOCK PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:COLONIAL HEIGHTS
Practice Address - State:VA
Practice Address - Zip Code:23834-2970
Practice Address - Country:US
Practice Address - Phone:804-520-1764
Practice Address - Fax:866-781-3220
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2016-02-23
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Provider Licenses
StateLicense IDTaxonomies
VA0101241485207RC0000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAVAA103818Medicare PIN