Healthcare Provider Details

I. General information

NPI: 1831359090
Provider Name (Legal Business Name): OMAR HAMDALLAH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2008
Last Update Date: 05/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5233 KING AVE SUITE 208
BALTIMORE MD
21237-4001
US

IV. Provider business mailing address

10845 PHILADELPHIA RD
WHITE MARSH MD
21162-1717
US

V. Phone/Fax

Practice location:
  • Phone: 410-918-1525
  • Fax: 410-918-1526
Mailing address:
  • Phone: 410-335-0008
  • Fax: 410-335-3113

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberD0077967
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: