Provider Demographics
NPI:1093721805
Name:CERMIK, OMER (MD)
Entity type:Individual
Prefix:
First Name:OMER
Middle Name:
Last Name:CERMIK
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 ELLENFIELD ST STE 101
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02905-4541
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1443 HARTFORD AVE
Practice Address - Street 2:
Practice Address - City:JOHNSTON
Practice Address - State:RI
Practice Address - Zip Code:02919-3224
Practice Address - Country:US
Practice Address - Phone:401-273-8100
Practice Address - Fax:401-861-8696
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD102132084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI007059462OtherMEDICARE ID-TYPE UNSPECIFIED
RI406989OtherBLUE CHIP
RI7007566Medicaid
RI15-26435OtherUBH
RI22129-8OtherBLUE CROSS
RI007059462OtherMEDICARE ID-TYPE UNSPECIFIED
RI7007566Medicaid
RI15-26435OtherUBH
RI1104847946OtherTHE PROVIDENCE CENTER NPI