Provider Demographics
NPI:1487690442
Name:O'MARA, EDWARD G (MD)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:G
Last Name:O'MARA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:510 UPPER CHESAPEAKE DR
Mailing Address - Street 2:417
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21014-4328
Mailing Address - Country:US
Mailing Address - Phone:443-643-3130
Mailing Address - Fax:443-643-3133
Practice Address - Street 1:510 UPPER CHESAPEAKE DR
Practice Address - Street 2:417
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21014-4328
Practice Address - Country:US
Practice Address - Phone:443-643-3130
Practice Address - Fax:443-643-3133
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2011-02-23
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Provider Licenses
StateLicense IDTaxonomies
MDD0055759207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDF65945Medicare UPIN