Provider Demographics
NPI:1811954571
Name:AWALE, OMAR M (MD)
Entity type:Individual
Prefix:
First Name:OMAR
Middle Name:M
Last Name:AWALE
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 1:2330 MORSE RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43229-5804
Mailing Address - Country:US
Mailing Address - Phone:614-428-8100
Mailing Address - Fax:614-428-8101
Practice Address - Street 1:2330 MORSE RD
Practice Address - Street 2:SUITE A
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43229-5804
Practice Address - Country:US
Practice Address - Phone:614-428-8100
Practice Address - Fax:614-428-8101
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-27
Last Update Date:2013-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35086218207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2577706Medicaid
I33572Medicare UPIN
AW4162891Medicare ID - Type Unspecified