Healthcare Provider Details

I. General information

NPI: 1205078417
Provider Name (Legal Business Name): OMI MEDICAL,INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2009
Last Update Date: 04/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1325 E WEST HWY SSMC2 ROOM 9300
SILVER SPRING MD
20910-3280
US

IV. Provider business mailing address

1325 E WEST HWY SSMC2 ROOM 9300
SILVER SPRING MD
20910-3280
US

V. Phone/Fax

Practice location:
  • Phone: 301-713-0545
  • Fax: 301-713-0379
Mailing address:
  • Phone: 301-713-0545
  • Fax: 301-713-0379

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License NumberR056145
License Number StateMD

VIII. Authorized Official

Name: MRS. CHRISTINE RUSSMAN
Title or Position: CONTRACT ADMINISTRATOR
Credential:
Phone: 301-270-9335