Healthcare Provider Details

I. General information

NPI: 1932328945
Provider Name (Legal Business Name): OMAR AHMED REDA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: OMAR MOHAMED

II. Dates (important events)

Enumeration Date: 04/25/2007
Last Update Date: 12/29/2022
Certification Date: 12/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4601 CORBETT DR
FORT COLLINS CO
80528-9579
US

IV. Provider business mailing address

4601 CORBETT DR
FORT COLLINS CO
80528-9579
US

V. Phone/Fax

Practice location:
  • Phone: 970-207-4857
  • Fax: 970-207-4885
Mailing address:
  • Phone: 970-207-4857
  • Fax: 970-207-4885

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD126132
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberDR.0068792
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: