Provider Demographics
NPI:1972527059
Name:ALI, OMAR A (MD)
Entity type:Individual
Prefix:
First Name:OMAR
Middle Name:A
Last Name:ALI
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:136 LINDEN DR
Mailing Address - Street 2:SUITE 104
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601-6900
Mailing Address - Country:US
Mailing Address - Phone:540-678-3588
Mailing Address - Fax:540-678-9025
Practice Address - Street 1:190 CAMPUS BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-2872
Practice Address - Country:US
Practice Address - Phone:540-662-0306
Practice Address - Fax:540-542-1843
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2020-02-14
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Provider Licenses
StateLicense IDTaxonomies
IL036111040207RC0000X
VA0101258918207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAP01570443OtherRR MEDICARE
VAP01570443OtherRR MEDICARE
WVWV6093B880Medicare PIN
VAVVJ135AMedicare PIN