Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0129X | Vascular Surgeon | 29164 | WV |
NPI | 1114334828 |
---|---|
Provider Name | Omar Nadra |
First Address | Martinsburg, WV 25401-9198 |
Second Address | Martinsburg, WV 25401-9198 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/07/2014 |
Last Update Date | 06/07/2021 |