Provider Demographics
NPI:1346462694
Name:BASHARMAL, AHMAD OMAR (MD)
Entity Type:Individual
Prefix:
First Name:AHMAD
Middle Name:OMAR
Last Name:BASHARMAL
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 1:42471 GREENSIDE DR
Mailing Address - Street 2:
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20148-5668
Mailing Address - Country:US
Mailing Address - Phone:937-305-9577
Mailing Address - Fax:
Practice Address - Street 1:3535 SALEM AVE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45406-2645
Practice Address - Country:US
Practice Address - Phone:937-276-8323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH57.008882207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine