Healthcare Provider Details

I. General information

NPI: 1104970540
Provider Name (Legal Business Name): OMAR AHMED MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 09/13/2024
Certification Date: 09/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1044 S FAIR OAKS AVE SUITE 110
PASADENA CA
91105-2622
US

IV. Provider business mailing address

1044 S FAIR OAKS AVE SUITE 110
PASADENA CA
91105-2622
US

V. Phone/Fax

Practice location:
  • Phone: 915-497-6534
  • Fax:
Mailing address:
  • Phone: 915-497-6534
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number060344
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code2086S0105X
TaxonomySurgery of the Hand (Surgery) Physician
License NumberA110375
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberA110375
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: