Provider Demographics
NPI:1164510905
Name:OSBORN, LAWRENCE WILLIAM (MD)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:WILLIAM
Last Name:OSBORN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:238 NORTHAMPTON ST
Mailing Address - Street 2:EASTHAMPTON HEALTH CENTER
Mailing Address - City:EASTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01027-1046
Mailing Address - Country:US
Mailing Address - Phone:413-529-9300
Mailing Address - Fax:413-282-3880
Practice Address - Street 1:238 NORTHAMPTON ST
Practice Address - Street 2:EASTHAMPTON HEALTH CENTER
Practice Address - City:EASTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01027-1046
Practice Address - Country:US
Practice Address - Phone:413-529-9300
Practice Address - Fax:413-282-3880
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2012-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA571442084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAOS A38349Medicare ID - Type UnspecifiedPART B PROVIDER NUMBER
MAH71106Medicare UPIN