Healthcare Provider Details

I. General information

NPI: 1154495018
Provider Name (Legal Business Name): OSAMA AL-OMAR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 E PRINCETON ST STE 310
ORLANDO FL
32803-1468
US

IV. Provider business mailing address

615 E PRINCETON ST STE 310
ORLANDO FL
32803-1468
US

V. Phone/Fax

Practice location:
  • Phone: 407-303-5781
  • Fax: 407-303-5794
Mailing address:
  • Phone: 407-303-5781
  • Fax: 407-303-5794

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2088P0231X
TaxonomyPediatric Urology Physician
License NumberME171729
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: