=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033918388
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ASIL OMAR PA-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/10/2025
-----------------------------------------------------
Last Update Date | 04/28/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 32550 DOCS PL UNIT 1
-----------------------------------------------------
City | MILLVILLE
-----------------------------------------------------
State | DE
-----------------------------------------------------
Zip | 19967-6975
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 302-541-4175
-----------------------------------------------------
Fax | 302-541-4217
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1515 SAVANNAH RD
-----------------------------------------------------
City | LEWES
-----------------------------------------------------
State | DE
-----------------------------------------------------
Zip | 19958-1675
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 302-645-3499
-----------------------------------------------------
Fax | 302-644-4830
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number | C5-0012253
-----------------------------------------------------
License Number State | DE
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------