Provider Demographics
NPI:1962913178
Name:OMAR, ALAA MABROUK SALEM (MD, PHD, FACC)
Entity type:Individual
Prefix:DR
First Name:ALAA
Middle Name:MABROUK SALEM
Last Name:OMAR
Suffix:
Gender:M
Credentials:MD, PHD, FACC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 490
Mailing Address - Street 2:
Mailing Address - City:MCCOMB
Mailing Address - State:MS
Mailing Address - Zip Code:39649-0490
Mailing Address - Country:US
Mailing Address - Phone:601-250-4366
Mailing Address - Fax:601-250-4367
Practice Address - Street 1:303 MARION AVE
Practice Address - Street 2:
Practice Address - City:MCCOMB
Practice Address - State:MS
Practice Address - Zip Code:39648-2707
Practice Address - Country:US
Practice Address - Phone:601-249-1350
Practice Address - Fax:601-249-1339
Is Sole Proprietor?:No
Enumeration Date:2017-10-14
Last Update Date:2024-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS33201207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology