Healthcare Provider Details

I. General information

NPI: 1730875683
Provider Name (Legal Business Name): MUHAMMAD OMER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2023
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10510 JEFFERSON AVE STE A
NEWPORT NEWS VA
23601-3102
US

IV. Provider business mailing address

1515 SAVANNAH RD FL 2
LEWES DE
19958-1675
US

V. Phone/Fax

Practice location:
  • Phone: 757-594-3800
  • Fax: 757-591-9021
Mailing address:
  • Phone: 302-645-3499
  • Fax: 302-644-4830

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberC2-0024988
License Number StateDE
# 2
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: