Provider Demographics
NPI:1114166352
Name:OMLOR, DEBRA ANN
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:ANN
Last Name:OMLOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:531 W GERMANTOWN PIKE # 200-201
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH MEETING
Mailing Address - State:PA
Mailing Address - Zip Code:19462-1325
Mailing Address - Country:US
Mailing Address - Phone:610-828-0400
Mailing Address - Fax:610-828-3869
Practice Address - Street 1:531 W GERMANTOWN PIKE # 200-201
Practice Address - Street 2:
Practice Address - City:PLYMOUTH MEETING
Practice Address - State:PA
Practice Address - Zip Code:19462-1325
Practice Address - Country:US
Practice Address - Phone:610-828-0400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-11
Last Update Date:2018-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA053438363A00000X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical