Provider Demographics
NPI:1477369551
Name:EL MUSTAFAH, OMAR HUSSEIN SALEM (MD)
Entity type:Individual
Prefix:
First Name:OMAR
Middle Name:HUSSEIN SALEM
Last Name:EL MUSTAFAH
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:96 JONATHAN LUCAS STREET MSC 620 SUITE 623-A
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29425-0001
Mailing Address - Country:US
Mailing Address - Phone:843-792-4538
Mailing Address - Fax:843-792-8523
Practice Address - Street 1:96 JONATHAN LUCAS STREET MSC 620 SUITE 623-A
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29425-0001
Practice Address - Country:US
Practice Address - Phone:843-792-4538
Practice Address - Fax:843-792-8523
Is Sole Proprietor?:No
Enumeration Date:2024-12-04
Last Update Date:2024-12-04
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Provider Licenses
StateLicense IDTaxonomies
SCLL93437208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology