MEDICARE: ALAAELDIN A OMAR M.D.

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
1	2080N0001X	Neonatal-Perinatal Medicine Physician	MD419696	PA
2	208000000X	Pediatrics Physician	MD419696	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	1701897	OTHER	PA	HIGHMARK

General Provider Information

NPI Number	:	1811976020
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALAAELDIN A OMAR M.D.

Provider Business Mailing Address
First Line	:	232 W 25TH ST
Second Line	:
City	:	ERIE
State	:	PA
Zip	:	16544-0002
Country	:	US
Telephone Number	:	814-452-5853
Fax Number	:	814-452-5583

Provider Business Practice Location Address
First Line	:	1611 PEACH ST
Second Line	:
City	:	ERIE
State	:	PA
Zip	:	16501-2109
Country	:	US
Telephone Number	:	814-454-2891
Fax Number	:	814-464-9480

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/16/2006
Last Update Date	:	10/05/2020

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