Provider Demographics
NPI:1629232897
Name:OMARA, MICHELLE WOOLAVER
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:WOOLAVER
Last Name:OMARA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 LYNNBROOK DRIVE
Mailing Address - Street 2:
Mailing Address - City:LAMBERTVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08530-3009
Mailing Address - Country:US
Mailing Address - Phone:609-730-0768
Mailing Address - Fax:
Practice Address - Street 1:7 LYNNBROOK DRIVE
Practice Address - Street 2:
Practice Address - City:LAMBERTVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08530-3009
Practice Address - Country:US
Practice Address - Phone:609-730-0768
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-16
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMD58514207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine