Provider Demographics
NPI:1689241846
Name:KHAMASH, ODAI QASIM A ABUDAGER (MD)
Entity type:Individual
Prefix:
First Name:ODAI
Middle Name:QASIM A ABUDAGER
Last Name:KHAMASH
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 SOUTH FRONT STREET
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17101-2010
Mailing Address - Country:US
Mailing Address - Phone:717-782-5118
Mailing Address - Fax:717-782-5854
Practice Address - Street 1:111 SOUTH FRONT STREET
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17101-2010
Practice Address - Country:US
Practice Address - Phone:717-782-5118
Practice Address - Fax:717-782-5854
Is Sole Proprietor?:No
Enumeration Date:2021-06-07
Last Update Date:2025-03-26
Deactivation Date:2023-04-03
Deactivation Code:
Reactivation Date:2024-12-23
Provider Licenses
StateLicense IDTaxonomies
390200000X
PAMD486596207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program