Healthcare Provider Details

I. General information

NPI: 1326123472
Provider Name (Legal Business Name): TIMOTHY J OMARA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8316 TRAFORD LN
SPRINGFIELD VA
22152
US

IV. Provider business mailing address

8316 TRAFORD LN
SPRINGFIELD VA
22152
US

V. Phone/Fax

Practice location:
  • Phone: 703-569-8400
  • Fax: 703-569-1182
Mailing address:
  • Phone: 703-569-8400
  • Fax: 703-569-1182

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101229984
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: