Healthcare Provider Details

I. General information

NPI: 1144291253
Provider Name (Legal Business Name): VALERIE ANN OMICIOLI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2006
Last Update Date: 10/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 UNIVERSITY BLVD
INDIANAPOLIS IN
46202-5149
US

IV. Provider business mailing address

1505 APPLECROFT LN
COCKEYSVILLE MD
21030-1601
US

V. Phone/Fax

Practice location:
  • Phone: 314-799-0273
  • Fax:
Mailing address:
  • Phone: 314-286-2447
  • Fax: 314-286-2455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number2006019886
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number01074576A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: