Provider Demographics
NPI:1952453565
Name:AMINI, MANOUCHEHR (MD)
Entity Type:Individual
Prefix:DR
First Name:MANOUCHEHR
Middle Name:
Last Name:AMINI
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 1:2601 ANNAND DR
Mailing Address - Street 2:SUITE 4
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19808-3719
Mailing Address - Country:US
Mailing Address - Phone:302-998-3334
Mailing Address - Fax:302-998-8985
Practice Address - Street 1:2601 ANNAND DR
Practice Address - Street 2:SUITE 4
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19808-3719
Practice Address - Country:US
Practice Address - Phone:302-998-3334
Practice Address - Fax:302-998-8985
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DECI0000475207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000958301Medicaid
AM090989Medicare ID - Type Unspecified
DE0000958301Medicaid