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General NPI Number Information
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NPI Number | 1538788278
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Entity Type | Individual
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Provider Name | OMAR GHISHAIRI
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Gender | Male
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Dates
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Enumeration Date | 04/13/2020
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Last Update Date | 10/14/2021
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Provider Practice Location Address
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Address Line | 88 WASHINGTON ST
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City | TAUNTON
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State | MA
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Zip | 02780-2465
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Country | US
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Telephone | 508-828-7000
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Fax |
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Provider Business Mailing Address
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Address Line | 16 BROAD ST
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City | RANDOLPH
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State | MA
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Zip | 02368-3202
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Country | US
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Telephone | 781-492-5740
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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