Provider Demographics
NPI:1073577391
Name:BAJWA, OMER AKHTAR (MD)
Entity Type:Individual
Prefix:
First Name:OMER
Middle Name:AKHTAR
Last Name:BAJWA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:490 E NORTH AVE
Mailing Address - Street 2:STE 300
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15212-4771
Mailing Address - Country:US
Mailing Address - Phone:412-322-7202
Mailing Address - Fax:412-322-2144
Practice Address - Street 1:490 E NORTH AVE
Practice Address - Street 2:STE 300
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15212-4771
Practice Address - Country:US
Practice Address - Phone:412-322-7202
Practice Address - Fax:412-322-2144
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2020-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD420770207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2644722Medicaid
WV3810003371Medicaid
PABA1759620Medicaid
I44587Medicare UPIN
PA095585NJYMedicare PIN
095585M6WMedicare ID - Type Unspecified