Provider Demographics
NPI:1104970540
Name:AHMED, OMAR (MD)
Entity type:Individual
Prefix:DR
First Name:OMAR
Middle Name:
Last Name:AHMED
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1044 S FAIR OAKS AVE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105-2622
Mailing Address - Country:US
Mailing Address - Phone:915-497-6534
Mailing Address - Fax:
Practice Address - Street 1:1044 S FAIR OAKS AVE
Practice Address - Street 2:SUITE 110
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-2622
Practice Address - Country:US
Practice Address - Phone:915-497-6534
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA060344208200000X
CAA1103752086S0105X, 208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No2086S0105XAllopathic & Osteopathic PhysiciansSurgerySurgery of the Hand