1831359090 NPI number — OMAR HAMDALLAH M.D.

Table of content: OMAR HAMDALLAH M.D. (NPI 1831359090)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831359090 NPI number — OMAR HAMDALLAH M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HAMDALLAH
Provider First Name:
OMAR
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1831359090
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/30/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10845 PHILADELPHIA RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WHITE MARSH
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21162-1717
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-335-0008
Provider Business Mailing Address Fax Number:
410-335-3113

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5233 KING AVE
Provider Second Line Business Practice Location Address:
SUITE 208
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21237-4001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-918-1525
Provider Business Practice Location Address Fax Number:
410-918-1526
Provider Enumeration Date:
06/11/2008

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: 2086S0129X , with the licence number:  D0077967 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 297413 . This is a "EMPLOYER HEALTH PROGRAMS (EHP)" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 4490 0002 . This is a "CAREFIRST" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 380791ZK7S . This is a "MEDICARE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: N/A . This is a "MEDSTAR FAMILY CHOICE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 297413 . This is a "US FAMILY HEALTH PLAN (USFHP)" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 740002100 . This is a "MEDICAL ASSISTANCE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 297413 . This is a "PRIORITY PARTNERS MCO (PPMCO)" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 4490 0002 . This is a "CAREFIRST" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".




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