Provider Demographics
NPI:1831187707
Name:SANYAL, AMIT (MD)
Entity type:Individual
Prefix:
First Name:AMIT
Middle Name:
Last Name:SANYAL
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 INDUSTRIAL AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:ME
Mailing Address - Zip Code:04073-5846
Mailing Address - Country:US
Mailing Address - Phone:207-459-1666
Mailing Address - Fax:207-661-8537
Practice Address - Street 1:27 INDUSTRIAL AVE STE 101
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:ME
Practice Address - Zip Code:04073-5846
Practice Address - Country:US
Practice Address - Phone:207-459-1666
Practice Address - Fax:207-661-8537
Is Sole Proprietor?:No
Enumeration Date:2005-10-13
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH25075207RH0000X, 207RX0202X
MEMD25646207RH0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematology
No207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEMD25646OtherLICENSE
NH25075OtherLICENSE
WI34710800Medicaid
WI040254340Medicare PIN
G82523Medicare UPIN
WIP00327313OtherRAILROAD MEDICARE