Provider Demographics
NPI:1033168315
Name:OSBORNE, BRADLEY J (MD)
Entity Type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:J
Last Name:OSBORNE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:9075 CENTRE POINTE DR
Mailing Address - Street 2:SUITE 160
Mailing Address - City:WEST CHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:45069-4890
Mailing Address - Country:US
Mailing Address - Phone:513-939-2263
Mailing Address - Fax:513-874-4569
Practice Address - Street 1:9075 CENTRE POINTE DR
Practice Address - Street 2:SUITE 160
Practice Address - City:WEST CHESTER
Practice Address - State:OH
Practice Address - Zip Code:45069-4890
Practice Address - Country:US
Practice Address - Phone:513-939-2263
Practice Address - Fax:513-874-4569
Is Sole Proprietor?:No
Enumeration Date:2006-05-06
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35068773O208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH01536313Medicaid
OH050785391Medicare PIN