1063513570 NPI number — FATIMAH OMAR JAH MD

Table of content: MISTIE DREWS (NPI 1508331976)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063513570 NPI number — FATIMAH OMAR JAH MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JAH
Provider First Name:
FATIMAH
Provider Middle Name:
OMAR
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SILLAH
Provider Other First Name:
FATIMAH
Provider Other Middle Name:
OMAR
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1063513570
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/05/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
101 MISSION ST STE 800
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN FRANCISCO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94105-1744
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-221-5140
Provider Business Mailing Address Fax Number:
415-231-5332

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
101 MISSION ST STE 800
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN FRANCISCO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94105-1744
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-221-5140
Provider Business Practice Location Address Fax Number:
415-231-5332
Provider Enumeration Date:
09/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  MD 28985 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 20-28985 . This is a "SC CONTROLLED SUB LIC #" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: 034 . This is a "TRICARE" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: 063 . This is a "BCBS" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: 20078187 . This is a "SELECT HEALTH" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: 000000245946 . This is a "UNISON" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: 062 . This is a "BCBS" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: 063 . This is a "BLUECHOICE" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: 1833944 . This is a "CIGNA" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: 211987 . This is a "MEDCOST" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: AA17288552 . This is a "MEDICARE PTAN" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: 032 . This is a "TRICARE" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: 289850 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 061 . This is a "BLUECHOICE" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: 5910322 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: MD 28985 . This is a "SC MEDICAL LICENSE" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".




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