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NPI Code Detail

MEDICARE: DR. OMAR ALI MBBCH

MEDICARE: DR. OMAR ALI MBBCH
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
1207RN0300XNephrology PhysicianMT237503PA
2390200000XStudent in an Organized Health Care Education/Training ProgramPA

General Provider Information

NPI Number : 1942989777
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. OMAR ALI MBBCH
Provider Business Mailing Address
First Line : 3401 N BROAD ST
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19140-5103
Country : US
Telephone Number : 215-707-3829
Fax Number :
Provider Business Practice Location Address
First Line : 3401 N BROAD ST
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19140-5103
Country : US
Telephone Number : 215-707-3829
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/18/2023
Last Update Date : 05/30/2026

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Directions to “ DR. OMAR ALI MBBCH” Practice Location

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