Healthcare Provider Details

I. General information

NPI: 1528174596
Provider Name (Legal Business Name): ELLEN M. O'MARA D.O., F.A.O.C.R.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2006
Last Update Date: 01/20/2025
Certification Date: 01/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

89 WARWICK RD
LITITZ PA
17543-8580
US

IV. Provider business mailing address

89 WARWICK RD
LITITZ PA
17543-8580
US

V. Phone/Fax

Practice location:
  • Phone: 717-626-7896
  • Fax:
Mailing address:
  • Phone: 717-626-7896
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberOS005338L
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier0012036340008
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: