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General NPI Number Information
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NPI Number | 1982267274
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Entity Type | Individual
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Provider Name | OMAR ALEXANDER PROTZUK MD
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Gender | Male
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Dates
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Enumeration Date | 04/22/2019
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Last Update Date | 08/13/2025
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Provider Practice Location Address
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Address Line | VCUHS DEPT OF ORTS RESIDENCY, 980153 1250 E. MARSHALL STREET
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City | RICHMOND
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State | VA
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Zip | 23298-0153
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Country | US
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Telephone | 804-827-1204
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Fax |
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Provider Business Mailing Address
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Address Line | 1200 E BROAD ST # 980153
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City | RICHMOND
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State | VA
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Zip | 23298-5025
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Country | US
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Telephone | 804-628-2676
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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 | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 1018532
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 207XX0005X
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Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
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License Number | 0101285954
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License Number State | VA
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