Healthcare Provider Details

I. General information

NPI: 1811976020
Provider Name (Legal Business Name): ALAAELDIN A OMAR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2006
Last Update Date: 10/05/2020
Certification Date: 10/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1611 PEACH ST
ERIE PA
16501-2109
US

IV. Provider business mailing address

232 W 25TH ST
ERIE PA
16544-0002
US

V. Phone/Fax

Practice location:
  • Phone: 814-454-2891
  • Fax: 814-464-9480
Mailing address:
  • Phone: 814-452-5853
  • Fax: 814-452-5583

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License NumberMD419696
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD419696
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: