MEDICARE: DR. OMAR AHMAD M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RH0003X	Hematology & Oncology Physician	MD29190	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1093779456
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. OMAR AHMAD M.D.

Provider Business Mailing Address
First Line	:	4772 NAVY RD STE A
Second Line	:
City	:	MILLINGTON
State	:	TN
Zip	:	38053-1927
Country	:	US
Telephone Number	:	901-873-0930
Fax Number	:	901-873-0931

Provider Business Practice Location Address
First Line	:	4772 NAVY RD STE A
Second Line	:
City	:	MILLINGTON
State	:	TN
Zip	:	38053-1927
Country	:	US
Telephone Number	:	901-873-0930
Fax Number	:	901-873-0931

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/13/2006
Last Update Date	:	05/12/2021

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