Active NPI
Omar Hallak, MD
- Cardiovascular Disease Physician
- Charleston, WV
National Provider Identifier
1689854929
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Cardiovascular Disease Physician
- License
- 19813
- Practice address
- 331 Laidley St
Suite 402
Charleston, WV 25301-1619 - Phone
- (304) 345-2090
- NPI assigned
- Nov 4, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Cardiovascular Disease Physician | 207RC0000X | 19813 | WV | Primary |
Addresses
Primary practice location
331 Laidley St
Suite 402
Charleston, WV 25301-1619
Mailing address
331 Laidley St
Suite 402
Charleston, WV 25301-1619
Phone (304) 345-2090
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 6000241000 | Medicaid | WV |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 19813 | WV | MD | Cardiovascular Disease Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1194134400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1194134400000",
"number": "1689854929",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "331 LAIDLEY ST",
"address_2": "SUITE 402",
"city": "CHARLESTON",
"state": "WV",
"postal_code": "253011619",
"telephone_number": "304-345-2090"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "331 LAIDLEY ST",
"address_2": "SUITE 402",
"city": "CHARLESTON",
"state": "WV",
"postal_code": "253011619",
"telephone_number": "304-345-2090"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HALLAK",
"first_name": "OMAR",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-11-04",
"last_updated": "2007-11-04",
"status": "A"
},
"taxonomies": [
{
"code": "207RC0000X",
"taxonomy_group": "",
"desc": "Internal Medicine, Cardiovascular Disease",
"state": "WV",
"license": "19813",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "6000241000",
"state": "WV"
}
],
"endpoints": [],
"other_names": []
}Other providers in Charleston, WV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.