Healthcare Provider Details

I. General information

NPI: 1619109493
Provider Name (Legal Business Name): OMAR SABRA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2009
Last Update Date: 08/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1941 LIMESTONE RD
WILMINGTON DE
19808-5408
US

IV. Provider business mailing address

2033 BENTWOOD CT
WILMINGTON DE
19804-3937
US

V. Phone/Fax

Practice location:
  • Phone: 302-998-0300
  • Fax:
Mailing address:
  • Phone: 302-379-1787
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0901X
TaxonomyOtology & Neurotology Physician
License NumberC7-0004377
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: