Provider Demographics
NPI:1093715310
Name:AHMAD, OMAR FAROOQ (MD)
Entity Type:Individual
Prefix:
First Name:OMAR
Middle Name:FAROOQ
Last Name:AHMAD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3460 OLD WASHINGTON RD
Mailing Address - Street 2:STE 302
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20602-3240
Mailing Address - Country:US
Mailing Address - Phone:301-893-3484
Mailing Address - Fax:301-893-3481
Practice Address - Street 1:3460 OLD WASHINGTON RD
Practice Address - Street 2:STE 302
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20602-3240
Practice Address - Country:US
Practice Address - Phone:301-893-3484
Practice Address - Fax:301-893-3481
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD0061689207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD405375300Medicaid
H64205Medicare UPIN
MDY186180002Medicare UPIN
MD405375300Medicaid
MD989M813FMedicare UPIN
DCY186180003Medicare UPIN