Provider Demographics
NPI:1063513570
Name:JAH, FATIMAH OMAR (MD)
Entity type:Individual
Prefix:
First Name:FATIMAH
Middle Name:OMAR
Last Name:JAH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:FATIMAH
Other - Middle Name:OMAR
Other - Last Name:SILLAH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:101 MISSION ST STE 800
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94105-1744
Mailing Address - Country:US
Mailing Address - Phone:800-221-5140
Mailing Address - Fax:415-231-5332
Practice Address - Street 1:101 MISSION ST STE 800
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94105-1744
Practice Address - Country:US
Practice Address - Phone:800-221-5140
Practice Address - Fax:415-231-5332
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCMD 28985207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC20-28985OtherSC CONTROLLED SUB LIC #
SC034OtherTRICARE
SC063OtherBCBS
SC20078187OtherSELECT HEALTH
SC000000245946OtherUNISON
SC062OtherBCBS
SC063OtherBLUECHOICE
SC1833944OtherCIGNA
SC211987OtherMEDCOST
SCAA17288552OtherMEDICARE PTAN
SC032OtherTRICARE
SC289850Medicaid
SC061OtherBLUECHOICE
NC5910322Medicaid
SCMD 28985OtherSC MEDICAL LICENSE
SC063OtherBCBS
NC5910322Medicaid
SC289850Medicaid