Provider Demographics
NPI:1093764607
Name:O'MARA, JAMES M (MD, PA)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:M
Last Name:O'MARA
Suffix:
Gender:M
Credentials:MD, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1450 PARKSIDE AVE
Mailing Address - Street 2:SUITE #20
Mailing Address - City:TRENTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08638-2946
Mailing Address - Country:US
Mailing Address - Phone:609-530-1818
Mailing Address - Fax:
Practice Address - Street 1:1450 PARKSIDE AVE
Practice Address - Street 2:SUITE #20
Practice Address - City:TRENTON
Practice Address - State:NJ
Practice Address - Zip Code:08638-2946
Practice Address - Country:US
Practice Address - Phone:609-530-1818
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-09
Last Update Date:2009-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA51871207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1296001Medicaid
NJ0466822000OtherAMERIHEALTH
NJ636640OtherMEDICARE
NJE61978Medicare UPIN
NJ150841ZDJ3Medicare PIN