Healthcare Provider Details

I. General information

NPI: 1003519901
Provider Name (Legal Business Name): OMAR GANDARILLA CUELLAR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2023
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 MANNING DR
CHAPEL HILL NC
27514-4226
US

IV. Provider business mailing address

170 MANNING DR CB#7305
CHAPEL HILL NC
27599-7305
US

V. Phone/Fax

Practice location:
  • Phone: 984-974-7831
  • Fax:
Mailing address:
  • Phone: 919-966-6735
  • Fax: 984-974-5050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: