Provider Demographics
NPI:1821383522
Name:MOTAMED, AMY LEIGH (DO)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:LEIGH
Last Name:MOTAMED
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:LEIGH
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10215 FERNWOOD RD STE 520
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20817-1184
Mailing Address - Country:US
Mailing Address - Phone:301-897-0099
Mailing Address - Fax:301-897-8537
Practice Address - Street 1:10215 FERNWOOD RD STE 520
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20817-1184
Practice Address - Country:US
Practice Address - Phone:301-897-0099
Practice Address - Fax:301-897-8537
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-10
Last Update Date:2022-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP44892084P0800X
MDH906902084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX270761YLRMMedicare PIN