Healthcare Provider Details

I. General information

NPI: 1548588775
Provider Name (Legal Business Name): CLINT JOSEPH OOMMEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2010
Last Update Date: 04/07/2021
Certification Date: 04/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 MATTHEW ST STE 302
MARIETTA OH
45750-1656
US

IV. Provider business mailing address

106 MILFORD STREET, SUITE 605
SALISBURY MD
21804
US

V. Phone/Fax

Practice location:
  • Phone: 740-568-5207
  • Fax:
Mailing address:
  • Phone: 410-334-2227
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number49431
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number35.137006
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: