Provider Demographics
NPI:1033086699
Name:OMAR, MOHAMUD SHAMUN
Entity type:Individual
Prefix:
First Name:MOHAMUD
Middle Name:SHAMUN
Last Name:OMAR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 DUTTON ST UNIT B
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03104-5080
Mailing Address - Country:US
Mailing Address - Phone:207-420-7465
Mailing Address - Fax:
Practice Address - Street 1:29 DUTTON ST UNIT B
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03104-5080
Practice Address - Country:US
Practice Address - Phone:207-420-7465
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-20
Last Update Date:2025-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NHNHL18369960342000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes342000000XTransportation ServicesTransportation Network Company