Basic Information
| Provider Information | |||||||||
| NPI: | 1376501882 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | AMIN | ||||||||
| FirstName: | SHAHRIAR | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5755 CEDAR LANE | ||||||||
| Address2: | JHCP INTENSIVIST GROUP | ||||||||
| City: | COLUMBIA | ||||||||
| State: | MD | ||||||||
| PostalCode: | 21044 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4107208695 | ||||||||
| FaxNumber: | 4107208580 | ||||||||
| Practice Location | |||||||||
| Address1: | 5755 CEDAR LANE | ||||||||
| Address2: | JHCP INTENSIVIST GROUP | ||||||||
| City: | COLUMBIA | ||||||||
| State: | MD | ||||||||
| PostalCode: | 21044 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4107208695 | ||||||||
| FaxNumber: | 4107208580 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/03/2006 | ||||||||
| LastUpdateDate: | 12/12/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0200X | D62273 | MD | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine |
ID Information
| ID | Type | State | Issuer | Description | 406051200 | 05 | MD | MEDICAID | 067935000 | 05 | MN | MEDICAID |