Provider Demographics
NPI:1144291253
Name:OMICIOLI, VALERIE ANN (MD)
Entity type:Individual
Prefix:DR
First Name:VALERIE
Middle Name:ANN
Last Name:OMICIOLI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1505 APPLECROFT LN
Mailing Address - Street 2:
Mailing Address - City:COCKEYSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21030-1601
Mailing Address - Country:US
Mailing Address - Phone:314-286-2447
Mailing Address - Fax:314-286-2455
Practice Address - Street 1:550 UNIVERSITY BLVD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-5149
Practice Address - Country:US
Practice Address - Phone:314-799-0273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2014-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006019886207VG0400X
IN01074576A207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO201245206Medicaid
IN201253640Medicaid
MO201245206Medicaid
IN896330015Medicare PIN
B41856Medicare UPIN
MO201245206Medicaid
IL$$$$$$$$$Medicaid