Provider Demographics
NPI:1124089453
Name:GABR, USAMA A (MD)
Entity type:Individual
Prefix:DR
First Name:USAMA
Middle Name:A
Last Name:GABR
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 1:113 BLARNEY DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29223-6244
Mailing Address - Country:US
Mailing Address - Phone:803-788-2225
Mailing Address - Fax:803-788-2120
Practice Address - Street 1:113 BLARNEY DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29223-6244
Practice Address - Country:US
Practice Address - Phone:803-788-2225
Practice Address - Fax:803-788-2120
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC28228207Q00000X, 208100000X
MI43011002325208100000X, 208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC282287Medicaid
I19808Medicare ID - Type Unspecified
I19808Medicare UPIN