Provider Demographics
NPI:1760448039
Name:OMAR, ARIF (MD)
Entity Type:Individual
Prefix:
First Name:ARIF
Middle Name:
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:PO BOX 66
Mailing Address - Street 2:
Mailing Address - City:CLARKSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26302-0066
Mailing Address - Country:US
Mailing Address - Phone:859-779-2260
Mailing Address - Fax:
Practice Address - Street 1:1 MEDICAL CENTER DR
Practice Address - Street 2:LOUIS A JOHNSON VAMC
Practice Address - City:CLARKSBURG
Practice Address - State:WV
Practice Address - Zip Code:26301-0066
Practice Address - Country:US
Practice Address - Phone:304-623-3461
Practice Address - Fax:304-326-7966
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2016-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY32517207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64325178Medicaid
KY00417001Medicare PIN
F40443Medicare UPIN