Provider Demographics
NPI:1518272459
Name:BEN OMRAN, MOHAMED
Entity Type:Individual
Prefix:DR
First Name:MOHAMED
Middle Name:
Last Name:BEN OMRAN
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 1:151 VERSAILLES CIR APT B
Mailing Address - Street 2:
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-6936
Mailing Address - Country:US
Mailing Address - Phone:617-953-8493
Mailing Address - Fax:
Practice Address - Street 1:1120 15TH ST
Practice Address - Street 2:GRU, DEPARTMENT OF ANESTHESIOLOGY
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30912-0004
Practice Address - Country:US
Practice Address - Phone:706-721-3873
Practice Address - Fax:706-721-7763
Is Sole Proprietor?:No
Enumeration Date:2010-08-16
Last Update Date:2015-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA74217207LC0200X, 207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LC0200XAllopathic & Osteopathic PhysiciansAnesthesiologyCritical Care Medicine