Provider Demographics
NPI:1508831405
Name:REGEN, AMANDA L (MD)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:L
Last Name:REGEN
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:12348 OLD TESSON RD STE 160
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63128-2251
Mailing Address - Country:US
Mailing Address - Phone:314-467-3800
Mailing Address - Fax:314-467-3801
Practice Address - Street 1:12348 OLD TESSON RD STE 160
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63128-2251
Practice Address - Country:US
Practice Address - Phone:314-467-3800
Practice Address - Fax:314-467-3801
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2019-07-03
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Provider Licenses
StateLicense IDTaxonomies
MO2005007822208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
I35134Medicare UPIN