Provider Demographics
NPI:1790833267
Name:AL OMARY, MALEK H (MD)
Entity Type:Individual
Prefix:MR
First Name:MALEK
Middle Name:H
Last Name:AL OMARY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:393 WALLACE RD
Mailing Address - Street 2:SUITE 104A
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37211
Mailing Address - Country:US
Mailing Address - Phone:615-331-4104
Mailing Address - Fax:615-331-9962
Practice Address - Street 1:393 WALLACE RD
Practice Address - Street 2:STE 104A INTERNAL MEDICINE LP
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37211
Practice Address - Country:US
Practice Address - Phone:615-331-4104
Practice Address - Fax:615-331-9962
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2010-06-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TNMD0000027510207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3097971Medicaid
TN3097973AMedicare PIN
TN3097971Medicare ID - Type Unspecified
TN3097971Medicaid