Provider Demographics
NPI:1831144765
Name:OTHMAN, WAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:WAEL
Middle Name:
Last Name:OTHMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:AHMD
Other - Middle Name:WAEL
Other - Last Name:HAGOTHMN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2302 NOBLEWOOD RD
Mailing Address - Street 2:
Mailing Address - City:EDGEWATER
Mailing Address - State:MD
Mailing Address - Zip Code:21037-3444
Mailing Address - Country:US
Mailing Address - Phone:410-956-5835
Mailing Address - Fax:
Practice Address - Street 1:4000 MITCHELLVILLE RD
Practice Address - Street 2:SUITE B216
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20716-3104
Practice Address - Country:US
Practice Address - Phone:301-262-0020
Practice Address - Fax:301-805-1124
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0060120207PE0004X, 207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD402826100Medicaid
MD584L-H582Medicare ID - Type Unspecified
MD402826100Medicaid