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General NPI Number Information
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NPI Number | 1811976020
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Entity Type | Individual
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Provider Name | ALAAELDIN A OMAR M.D.
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Gender | Male
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Dates
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Enumeration Date | 01/16/2006
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Last Update Date | 10/05/2020
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Provider Practice Location Address
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Address Line | 1611 PEACH ST
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City | ERIE
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State | PA
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Zip | 16501-2109
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Country | US
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Telephone | 814-454-2891
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Fax | 814-464-9480
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Provider Business Mailing Address
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Address Line | 232 W 25TH ST
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City | ERIE
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State | PA
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Zip | 16544-0002
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Country | US
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Telephone | 814-452-5853
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Fax | 814-452-5583
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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 | 2080N0001X
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Taxonomy Name | Neonatal-Perinatal Medicine Physician
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License Number | MD419696
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | MD419696
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License Number State | PA
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