Healthcare Provider Details

I. General information

NPI: 1033530761
Provider Name (Legal Business Name): DR. OMAR CHAMDINE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/24/2013
Last Update Date: 11/11/2025
Certification Date: 11/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

262 DANNY THOMAS PL
MEMPHIS TN
38105-3678
US

IV. Provider business mailing address

282 N B B KING BLVD APT 202
MEMPHIS TN
38105-3556
US

V. Phone/Fax

Practice location:
  • Phone: 901-595-3300
  • Fax:
Mailing address:
  • Phone: 901-595-6667
  • Fax: 901-595-4386

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License Number75318
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: