Provider Demographics
NPI:1003824640
Name:OSBORNE, CYNTHIA M (DO)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:M
Last Name:OSBORNE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 946
Mailing Address - Street 2:
Mailing Address - City:CRAIGSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:26205-0946
Mailing Address - Country:US
Mailing Address - Phone:304-742-5737
Mailing Address - Fax:304-742-5738
Practice Address - Street 1:46 RED OAK DR
Practice Address - Street 2:
Practice Address - City:CRAIGSVILLE
Practice Address - State:WV
Practice Address - Zip Code:26205-3102
Practice Address - Country:US
Practice Address - Phone:304-742-5737
Practice Address - Fax:304-742-5738
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1449207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0046926000Medicaid
WV0046926000Medicaid
WVG36578Medicare UPIN