Provider Demographics
NPI:1063480465
Name:OSBORNE, PAUL D (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:D
Last Name:OSBORNE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:9 RICHLAND MEDICAL PARK
Mailing Address - Street 2:SUITE 330
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29203-6859
Mailing Address - Country:US
Mailing Address - Phone:800-290-5309
Mailing Address - Fax:803-434-4354
Practice Address - Street 1:11803 JEFFERSON AVE
Practice Address - Street 2:SUITE 120
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-2565
Practice Address - Country:US
Practice Address - Phone:757-594-1060
Practice Address - Fax:757-594-1066
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101040968207P00000X, 207PE0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Not Answered207PE0005XAllopathic & Osteopathic PhysiciansEmergency MedicineUndersea and Hyperbaric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA002676H39Medicare ID - Type Unspecified
B91541Medicare UPIN