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General NPI Number Information
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NPI Number | 1891712220
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Entity Type | Individual
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Provider Name | HATIM A OMAR MD
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Gender | Male
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Dates
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Enumeration Date | 07/15/2006
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Last Update Date | 01/08/2021
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Provider Practice Location Address
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Address Line | 740 S LIMESTONE
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City | LEXINGTON
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State | KY
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Zip | 40536-0001
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Country | US
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Telephone | 859-323-5481
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Fax |
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Provider Business Mailing Address
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Address Line | 2100 MACK BLVD
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City | ALLENTOWN
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State | PA
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Zip | 18103-5622
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Country | US
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Telephone | 484-884-0617
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Fax | 484-884-0628
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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 | 2080A0000X
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Taxonomy Name | Pediatric Adolescent Medicine Physician
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License Number | 34630
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 2080A0000X
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Taxonomy Name | Pediatric Adolescent Medicine Physician
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License Number | MD055065L
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License Number State | PA
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