Healthcare Provider Details

I. General information

NPI: 1780820522
Provider Name (Legal Business Name): OSAMA GOMAA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2008
Last Update Date: 06/08/2022
Certification Date: 06/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21355 E DIXIE HWY STE 101&107
AVENTURA FL
33180
US

IV. Provider business mailing address

21355 E DIXIE HWY # 107101
AVENTURA FL
33180-1238
US

V. Phone/Fax

Practice location:
  • Phone: 305-705-4775
  • Fax: 786-955-8100
Mailing address:
  • Phone: 727-688-3540
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberTRN12117
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License NumberME107857
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License NumberME107857
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code2085N0904X
TaxonomyNuclear Radiology Physician
License NumberME107857
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberME107857
License Number StateFL
# 6
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberME107857
License Number StateFL
# 7
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License NumberME107857
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: