Individual
OMAR A KHASHABA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
110 LONGWOOD AVE, ROCKLEDGE, FL 32955-2828
(321) 636-2211
Mailing address
110 LONGWOOD AVE, ROCKLEDGE, FL 32955-2828
(321) 636-2211
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
97357
GA
207R00000X
Internal Medicine Physician
ME112373
FL
208M00000X
Hospitalist Physician
Primary
ME112373
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004665600
—
FL
01
—
FY303P
MEDICARE PTAN
FL
01
—
FY303T
MEDICARE PTAN
FL
01
—
P02008560
RRMEDICARE PTAN
FL
Enumeration date
05/21/2008
Last updated
05/16/2025
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