Provider Demographics
NPI:1376594069
Name:HUSSAMY, OMAR DAVID (MD)
Entity type:Individual
Prefix:DR
First Name:OMAR
Middle Name:DAVID
Last Name:HUSSAMY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1260 37TH ST STE 102
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-6567
Mailing Address - Country:US
Mailing Address - Phone:772-213-9800
Mailing Address - Fax:772-213-9813
Practice Address - Street 1:1717 INDIAN RIVER BLVD STE 202B
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-0864
Practice Address - Country:US
Practice Address - Phone:772-213-9800
Practice Address - Fax:772-213-9813
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2025-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME65456207X00000X
IL036175057207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL200025538OtherRAILROAD MEDICARE
FL23805OtherBCBS
FL23805OtherBCBS
FL23805ZMedicare PIN