Provider Demographics
NPI:1083712921
Name:AL-OMARI, MALIK A (MD)
Entity Type:Individual
Prefix:
First Name:MALIK
Middle Name:A
Last Name:AL-OMARI
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 1:7501 SURRATTS RD STE 304
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MD
Mailing Address - Zip Code:20735-3377
Mailing Address - Country:US
Mailing Address - Phone:301-877-5677
Mailing Address - Fax:
Practice Address - Street 1:7501 SURRATTS RD STE 304
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MD
Practice Address - Zip Code:20735-3377
Practice Address - Country:US
Practice Address - Phone:301-877-5677
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2022-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD82880207R00000X, 207RC0000X
KY31256207RI0011X
MN49477207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
H81746Medicare UPIN
MN930003422Medicare PIN