Provider Demographics
NPI:1194473009
Name:OMAR, MOHAMED AHMED
Entity Type:Individual
Prefix:
First Name:MOHAMED
Middle Name:AHMED
Last Name:OMAR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 CHARLESTOWN RD
Mailing Address - Street 2:
Mailing Address - City:CLAREMONT
Mailing Address - State:NH
Mailing Address - Zip Code:03743-5615
Mailing Address - Country:US
Mailing Address - Phone:603-558-2035
Mailing Address - Fax:
Practice Address - Street 1:6100 OAK TREE BLVD
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:OH
Practice Address - Zip Code:44131-2544
Practice Address - Country:US
Practice Address - Phone:603-558-2035
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-10
Last Update Date:2022-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)