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NPI Code Detail

MEDICARE: MS. BAHJA MOHAMED OMAR

MEDICARE: MS. BAHJA MOHAMED OMAR
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TM1800XIntellectual & Developmental Disabilities Psychologist

General Provider Information

NPI Number : 1801626189
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. BAHJA MOHAMED OMAR
Provider Business Mailing Address
First Line : 938 6TH ST E
Second Line :
City : SAINT PAUL
State : MN
Zip : 55106-4504
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 938 6TH ST E
Second Line :
City : SAINT PAUL
State : MN
Zip : 55106-4504
Country : US
Telephone Number : 315-450-7121
Fax Number : 651-389-0540
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/02/2024
Last Update Date : 08/02/2024

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