Healthcare Provider Details

I. General information

NPI: 1073891412
Provider Name (Legal Business Name): OMAYA IBRAHIM BANIHANI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: OMAYA IBRAHIM BANIHANI M.D

II. Dates (important events)

Enumeration Date: 08/03/2011
Last Update Date: 09/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 OAK HILL DRIVE APT 202
PITTSBURGH PA
15213
US

IV. Provider business mailing address

4401 PENN AVE CHILDREN HOSPITAL OF PITTSBURGH
PITTSBURGH PA
15224-1334
US

V. Phone/Fax

Practice location:
  • Phone: 302-377-5866
  • Fax:
Mailing address:
  • Phone: 302-377-5866
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2088P0231X
TaxonomyPediatric Urology Physician
License NumberMT202414
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberC7-0004880
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: