Provider Demographics
NPI:1154687499
Name:OSBORNE, ELEANOR MARSHALL (MD)
Entity Type:Individual
Prefix:
First Name:ELEANOR
Middle Name:MARSHALL
Last Name:OSBORNE
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 1:2004 HAYES STREET
Mailing Address - Street 2:SUITE 800
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-3722
Mailing Address - Country:US
Mailing Address - Phone:615-514-6963
Mailing Address - Fax:615-986-0560
Practice Address - Street 1:2410 PATTERSON ST
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-1551
Practice Address - Country:US
Practice Address - Phone:615-342-4850
Practice Address - Fax:615-342-4901
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-11
Last Update Date:2018-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN554832085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100472420Medicaid
TNQ028324Medicaid