Provider Demographics
NPI:1932528122
Name:ZEIDAN, AMY JOSEPHINE (MD)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:JOSEPHINE
Last Name:ZEIDAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 ROSE ST RM M53
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40536-0298
Mailing Address - Country:US
Mailing Address - Phone:859-323-5908
Mailing Address - Fax:859-323-8056
Practice Address - Street 1:800 ROSE ST
Practice Address - Street 2:ROOM M53
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40536
Practice Address - Country:US
Practice Address - Phone:859-323-5908
Practice Address - Fax:859-323-8056
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-15
Last Update Date:2019-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD459841207P00000X
GA82796207P00000X
KY51626207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine