Basic Information
| Provider Information | |||||||||
| NPI: | 1376896902 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MOHAMAD AMIN | ||||||||
| FirstName: | BAKHTIAR | ||||||||
| MiddleName: | K | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 40 VALLEY STREAM PKWY STE 100 | ||||||||
| Address2: | |||||||||
| City: | MALVERN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 193551407 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6106448900 | ||||||||
| FaxNumber: | 4849240053 | ||||||||
| Practice Location | |||||||||
| Address1: | 4600 SMITH RD # A4 | ||||||||
| Address2: | |||||||||
| City: | NORWOOD | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452122793 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5133512494 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/19/2012 | ||||||||
| LastUpdateDate: | 07/26/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/26/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RN0300X | MD208246 | LA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207RN0300X | 35.146195 | OH | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology |
No ID Information.