Provider Demographics
NPI:1245236587
Name:OMAR, MAJDI A (MD)
Entity Type:Individual
Prefix:
First Name:MAJDI
Middle Name:A
Last Name:OMAR
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 1:5510 UTICA RIDGE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52807-2935
Mailing Address - Country:US
Mailing Address - Phone:563-424-2025
Mailing Address - Fax:563-424-2042
Practice Address - Street 1:5510 UTICA RIDGE RD STE 100
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52807-2935
Practice Address - Country:US
Practice Address - Phone:563-424-2025
Practice Address - Fax:563-424-2042
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-22
Last Update Date:2014-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA32037208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA4225250Medicaid
I3098Medicare PIN
G59880Medicare UPIN