Basic Information
| Provider Information | |||||||||
| NPI: | 1497903678 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ELKHAMRA | ||||||||
| FirstName: | OMAR | ||||||||
| MiddleName: | YOUSSEF | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2405 ATHERHOLT RD | ||||||||
| Address2: | |||||||||
| City: | LYNCHBURG | ||||||||
| State: | VA | ||||||||
| PostalCode: | 245012184 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4344858500 | ||||||||
| FaxNumber: | 4344858599 | ||||||||
| Practice Location | |||||||||
| Address1: | 2405 ATHERHOLT RD | ||||||||
| Address2: | |||||||||
| City: | LYNCHBURG | ||||||||
| State: | VA | ||||||||
| PostalCode: | 245012184 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4344858500 | ||||||||
| FaxNumber: | 4344858599 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2008 | ||||||||
| LastUpdateDate: | 06/08/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/08/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RS0010X | MT202855 | PA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Sports Medicine | 207RS0010X | 0101254352 | VA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Sports Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1497903678 | 05 | VA | MEDICAID |