Individual
MOHAMMAD MASIHUDDIN OMAR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
185 GENESEE ST, SUITE 600, UTICA, NY 13501-2199
(315) 793-8806
(315) 793-8046
Mailing address
185 GENESEE ST, SUITE 600, UTICA, NY 13501-2199
(315) 793-8806
(315) 793-8046
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
126621
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00596667
—
NY
01
—
0086963
GHI
NY
01
—
040426014046
FIDELIS
NY
01
—
10024325
CDPHP
NY
01
—
126621-2
WC
NY
01
—
225115
MVP
NY
01
—
300021947
RAIL ROAD MEDICARE
NY
01
—
P010126621
BCBS
NY
Enumeration date
05/04/2006
Last updated
01/26/2012
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