Provider Demographics
NPI:1215411061
Name:AGGARWAL, OMAR (CRNA)
Entity Type:Individual
Prefix:
First Name:OMAR
Middle Name:
Last Name:AGGARWAL
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 COMMONWEALTH AVE APT 11
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-2782
Mailing Address - Country:US
Mailing Address - Phone:956-459-2710
Mailing Address - Fax:
Practice Address - Street 1:400 COMMONWEALTH AVE APT 11
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-2782
Practice Address - Country:US
Practice Address - Phone:956-459-2710
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-18
Last Update Date:2019-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX841393163WC0200X
TXAP141164367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine