Provider Demographics
NPI:1780882852
Name:AMIN, MANSI (DO)
Entity type:Individual
Prefix:
First Name:MANSI
Middle Name:
Last Name:AMIN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 W CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGBORO
Mailing Address - State:OH
Mailing Address - Zip Code:45066-1106
Mailing Address - Country:US
Mailing Address - Phone:937-208-7100
Mailing Address - Fax:937-208-7125
Practice Address - Street 1:360 W CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:SPRINGBORO
Practice Address - State:OH
Practice Address - Zip Code:45066-1106
Practice Address - Country:US
Practice Address - Phone:937-208-7100
Practice Address - Fax:937-208-7125
Is Sole Proprietor?:No
Enumeration Date:2007-07-10
Last Update Date:2020-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34008472207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2820675Medicaid
OH2820675Medicaid
OHH004450Medicare PIN