Provider Demographics
NPI:1841242963
Name:O'MARA, SEAN (MD)
Entity Type:Individual
Prefix:DR
First Name:SEAN
Middle Name:
Last Name:O'MARA
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 1:161 FORT EVANS RD NE STE 255
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20176
Mailing Address - Country:US
Mailing Address - Phone:703-962-6721
Mailing Address - Fax:866-269-0997
Practice Address - Street 1:161 FORT EVANS RD NE STE255
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176
Practice Address - Country:US
Practice Address - Phone:703-962-6721
Practice Address - Fax:866-269-0997
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2012-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101239452207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810003148Medicaid
VAP00368729Medicare PIN
MDI41268Medicare UPIN
WV3810003148Medicaid