Provider Demographics
NPI:1700917150
Name:AL-AMIN, TONY T (MD)
Entity Type:Individual
Prefix:
First Name:TONY
Middle Name:T
Last Name:AL-AMIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:747 FREDERICK ROAD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CATONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21228
Mailing Address - Country:US
Mailing Address - Phone:410-747-2570
Mailing Address - Fax:410-747-2538
Practice Address - Street 1:757 FREDERICK RD
Practice Address - Street 2:SUITE 100
Practice Address - City:CATONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21228-4500
Practice Address - Country:US
Practice Address - Phone:410-747-2570
Practice Address - Fax:410-747-2538
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2011-10-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA080507002081P2900X, 2081S0010X
DEC1-00085232081P2900X, 2081S0010X
MDD00681162081P2900X
MDMD00681162081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
No2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD131526ZACGMedicare UPIN
DE131525ZAJMedicare UPIN