Provider Demographics
NPI:1093779456
Name:AHMAD, OMAR (MD)
Entity Type:Individual
Prefix:DR
First Name:OMAR
Middle Name:
Last Name:AHMAD
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 1:4772 NAVY RD STE A
Mailing Address - Street 2:
Mailing Address - City:MILLINGTON
Mailing Address - State:TN
Mailing Address - Zip Code:38053-1927
Mailing Address - Country:US
Mailing Address - Phone:901-873-0930
Mailing Address - Fax:901-873-0931
Practice Address - Street 1:4772 NAVY RD STE A
Practice Address - Street 2:
Practice Address - City:MILLINGTON
Practice Address - State:TN
Practice Address - Zip Code:38053-1927
Practice Address - Country:US
Practice Address - Phone:901-873-0930
Practice Address - Fax:901-873-0931
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD29190207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3850166Medicaid
TN6091820001Medicare NSC
TN3850166Medicaid
3850166Medicare UPIN
G20301Medicare UPIN