Provider Demographics
NPI:1750566030
Name:WHARTON-ALI, OMER HAMID (MD)
Entity type:Individual
Prefix:
First Name:OMER
Middle Name:HAMID
Last Name:WHARTON-ALI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 364479
Mailing Address - Street 2:
Mailing Address - City:N LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89036-8479
Mailing Address - Country:US
Mailing Address - Phone:702-399-3404
Mailing Address - Fax:702-399-1819
Practice Address - Street 1:1703 CIVIC CENTER DR STE 1B
Practice Address - Street 2:
Practice Address - City:N LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89030-7273
Practice Address - Country:US
Practice Address - Phone:702-399-3404
Practice Address - Fax:702-399-1819
Is Sole Proprietor?:No
Enumeration Date:2008-01-04
Last Update Date:2008-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV3863208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVC96696Medicare UPIN
NVVMD3863Medicare PIN