Basic Information
| Provider Information | |||||||||
| NPI: | 1952980526 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | MOHAMED | ||||||||
| FirstName: | OMAR | ||||||||
| MiddleName: | AYMAN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 395 W 12TH AVE FL 4 | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432101267 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6146850759 | ||||||||
| FaxNumber: | 6142936935 | ||||||||
| Practice Location | |||||||||
| Address1: | 395 W 12TH AVE FL 4 | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432101267 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6146850759 | ||||||||
| FaxNumber: | 6142936935 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/02/2021 | ||||||||
| LastUpdateDate: | 10/06/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/04/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0204X | 57.251023 | OH | Y | Allopathic & Osteopathic Physicians | Radiology | Vascular & Interventional Radiology |
No ID Information.