Provider Demographics
NPI:1336126812
Name:OSLEY, ROBERT P (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:P
Last Name:OSLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:256 NORTH MAIN STREET
Mailing Address - Street 2:HARTFORD MEDICAL GROUP
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06042
Mailing Address - Country:US
Mailing Address - Phone:860-696-2300
Mailing Address - Fax:860-645-3216
Practice Address - Street 1:256 NORTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06040
Practice Address - Country:US
Practice Address - Phone:860-646-8595
Practice Address - Fax:860-645-3216
Is Sole Proprietor?:No
Enumeration Date:2005-12-27
Last Update Date:2012-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT028080207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001280809Medicaid
B38633Medicare UPIN
CT001280809Medicaid
CT080001477Medicare PIN