Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | 01074576A | IN |
N | 207VG0400X | Gynecologist | 2006019886 | MO |
NPI | 1144291253 |
---|---|
Provider Name | Dr. Valerie Ann Omicioli |
First Address | Cockeysville, MD 21030-1601 |
Second Address | Indianapolis, IN 46202-5149 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/01/2006 |
Last Update Date | 27/10/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
201245206 | (05) | MO |
201253640 | (05) | IN |
B41856 | (02) |