Healthcare Provider Details

I. General information

NPI: 1801591664
Provider Name (Legal Business Name): OMAR BASHIR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2023
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1530 8TH AVE FL 1
BETHLEHEM PA
18018-1883
US

IV. Provider business mailing address

1700 ST LUKES BLVD STE 200
EASTON PA
18045-5670
US

V. Phone/Fax

Practice location:
  • Phone: 484-503-0055
  • Fax:
Mailing address:
  • Phone: 484-503-0055
  • Fax:

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: