Provider Demographics
NPI:1528174596
Name:O'MARA, ELLEN M (DO, FAOCR)
Entity type:Individual
Prefix:
First Name:ELLEN
Middle Name:M
Last Name:O'MARA
Suffix:
Gender:F
Credentials:DO, FAOCR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:89 WARWICK RD
Mailing Address - Street 2:
Mailing Address - City:LITITZ
Mailing Address - State:PA
Mailing Address - Zip Code:17543-8580
Mailing Address - Country:US
Mailing Address - Phone:717-626-7896
Mailing Address - Fax:
Practice Address - Street 1:89 WARWICK RD
Practice Address - Street 2:
Practice Address - City:LITITZ
Practice Address - State:PA
Practice Address - Zip Code:17543-8580
Practice Address - Country:US
Practice Address - Phone:717-626-7896
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2025-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS005338L2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0012036340008Medicaid
PAE79116Medicare UPIN
PA0012036340008Medicaid