Healthcare Provider Details

I. General information

NPI: 1891716809
Provider Name (Legal Business Name): OMED, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2006
Last Update Date: 06/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1290 DIAMOND SPRINGS RD
VIRGINIA BEACH VA
23455-3701
US

IV. Provider business mailing address

704 THIMBLE SHOALS BLVD SUITE 200
NEWPORT NEWS VA
23606-4544
US

V. Phone/Fax

Practice location:
  • Phone: 757-460-0700
  • Fax: 757-460-4168
Mailing address:
  • Phone: 757-240-5580
  • Fax: 757-240-5578

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. N. MICHAEL BADDAR
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 757-825-1100