Provider Demographics
NPI:1891815247
Name:AMIR, IMRAN (MD)
Entity Type:Individual
Prefix:DR
First Name:IMRAN
Middle Name:
Last Name:AMIR
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 1:3260 TILLMAN DR
Mailing Address - Street 2:SUITE 120
Mailing Address - City:BENSALEM
Mailing Address - State:PA
Mailing Address - Zip Code:19020-2029
Mailing Address - Country:US
Mailing Address - Phone:267-332-0321
Mailing Address - Fax:267-332-0323
Practice Address - Street 1:3260 TILLMAN DR
Practice Address - Street 2:SUITE 120
Practice Address - City:BENSALEM
Practice Address - State:PA
Practice Address - Zip Code:19020-2029
Practice Address - Country:US
Practice Address - Phone:267-332-0321
Practice Address - Fax:267-332-0323
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2014-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD420353207N00000X, 207ND0101X, 207NS0135X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA129849Medicare PIN
G25847Medicare UPIN
PAP00772110Medicare PIN
PA241427Medicare PIN
PA129849V4BMedicare PIN