Provider Demographics
NPI:1750374674
Name:AMIT, AVRAHAM RAMI (MD)
Entity type:Individual
Prefix:DR
First Name:AVRAHAM
Middle Name:RAMI
Last Name:AMIT
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 1:3785 EDINBURGH DR
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44511-1171
Mailing Address - Country:US
Mailing Address - Phone:330-793-2058
Mailing Address - Fax:330-884-3163
Practice Address - Street 1:510 GYPSY LN
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44504-1349
Practice Address - Country:US
Practice Address - Phone:330-884-5776
Practice Address - Fax:330-884-3163
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-25
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-07-2114-A174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC021883M65Medicare PIN