Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0000X | Internist - Cardiovascular Disease | 0101257400 | VA |
N | 207RC0000X | Internist - Cardiovascular Disease | ME114846 | FL |
N | 207RC0001X | Clinical Cardiac Electrophysiologist | ME114846 | FL |
NPI | 1093906133 |
---|---|
Provider Name | Omar F Shams |
First Address | Midlothian, VA 23114-3222 |
Second Address | Midlothian, VA 23114-3222 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/08/2007 |
Last Update Date | 26/05/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C09462 | GROUP PTAN (01) | VA |