Provider Demographics
NPI:1376594903
Name:OSMANI, OMAR NIZAR (MD)
Entity Type:Individual
Prefix:DR
First Name:OMAR
Middle Name:NIZAR
Last Name:OSMANI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:400 N PENNSYLVANIA AVE
Mailing Address - Street 2:SUITE101
Mailing Address - City:ROSWELL
Mailing Address - State:NM
Mailing Address - Zip Code:88201-4754
Mailing Address - Country:US
Mailing Address - Phone:575-623-9101
Mailing Address - Fax:575-623-3020
Practice Address - Street 1:400 N PENNSYLVANIA AVE
Practice Address - Street 2:SUITE101
Practice Address - City:ROSWELL
Practice Address - State:NM
Practice Address - Zip Code:88201-4754
Practice Address - Country:US
Practice Address - Phone:575-623-9101
Practice Address - Fax:575-623-3020
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2013-12-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NM2002-0310207X00000X, 207XS0117X, 207XS0114X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
No207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM37026259Medicaid