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Individual
MR. PETER OMONDE II
Active
Individual
MR. PETER OMONDE II
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
102580
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
341871
FQHC MEDICARE
NC
01
—
344591A/344591C
FQHC MEDICAID
NC
05
—
344591C
—
NC
Enumeration date
02/07/2006
Last updated
04/15/2015
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