Provider Demographics
NPI:1245907617
Name:RAHMAN, AMITAV ANTHONY (PA-C)
Entity type:Individual
Prefix:
First Name:AMITAV
Middle Name:ANTHONY
Last Name:RAHMAN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9895 W REMINGTON PL
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80128-6734
Mailing Address - Country:US
Mailing Address - Phone:303-948-2676
Mailing Address - Fax:303-904-9151
Practice Address - Street 1:9895 W REMINGTON PL
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80128-6734
Practice Address - Country:US
Practice Address - Phone:303-948-2676
Practice Address - Fax:303-904-9151
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-24
Last Update Date:2022-01-11
Deactivation Date:2021-12-06
Deactivation Code:
Reactivation Date:2022-01-11
Provider Licenses
StateLicense IDTaxonomies
PAOA005852363A00000X
PA363A00000X
363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty