Provider Demographics
NPI:1750394102
Name:AMINA, SURESH P (MD)
Entity type:Individual
Prefix:DR
First Name:SURESH
Middle Name:P
Last Name:AMINA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2623 WILMINGTON RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:NEW CASTLE
Mailing Address - State:PA
Mailing Address - Zip Code:16105-1529
Mailing Address - Country:US
Mailing Address - Phone:724-658-7790
Mailing Address - Fax:724-658-5767
Practice Address - Street 1:2623 WILMINGTON RD
Practice Address - Street 2:SUITE B
Practice Address - City:NEW CASTLE
Practice Address - State:PA
Practice Address - Zip Code:16105-1529
Practice Address - Country:US
Practice Address - Phone:724-658-7790
Practice Address - Fax:724-658-5767
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2008-03-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMD038171L208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0836704Medicaid
C30474Medicare UPIN
PA112138Medicare ID - Type Unspecified