Provider Demographics
NPI:1073610887
Name:OSBORN, JESSICA L (MD)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:L
Last Name:OSBORN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1120 19TH ST NW
Mailing Address - Street 2:SUITE #200
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20036-3605
Mailing Address - Country:US
Mailing Address - Phone:202-296-0670
Mailing Address - Fax:
Practice Address - Street 1:1120 19TH ST NW
Practice Address - Street 2:SUITE #200
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20036-3605
Practice Address - Country:US
Practice Address - Phone:202-296-0670
Practice Address - Fax:202-331-8924
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD33879207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine