Individual
DR. OMAR AGOSTO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3401 N BROAD ST, PHILADELPHIA, PA 19140-5103
(215) 707-7237
(215) 707-9386
Mailing address
2450 W HUNTING PARK AVE, PHILADELPHIA, PA 19129-1302
(215) 707-7237
(215) 707-9386
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
2007013148
MO
2085R0202X
Diagnostic Radiology Physician
Primary
MD427190
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
102077779-0001
—
PA
Enumeration date
06/10/2007
Last updated
06/07/2013
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