Provider Demographics
NPI:1356498489
Name:OSUCH, DANIEL B (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:B
Last Name:OSUCH
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 1:313 SPEEN ST
Mailing Address - Street 2:
Mailing Address - City:NATICK
Mailing Address - State:MA
Mailing Address - Zip Code:01760-1538
Mailing Address - Country:US
Mailing Address - Phone:508-655-0471
Mailing Address - Fax:508-650-3547
Practice Address - Street 1:313 SPEEN ST
Practice Address - Street 2:
Practice Address - City:NATICK
Practice Address - State:MA
Practice Address - Zip Code:01760-1538
Practice Address - Country:US
Practice Address - Phone:508-655-0471
Practice Address - Fax:508-650-3547
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2011-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA221020207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110086750AMedicaid
MA110086750AMedicaid
001770201Medicare PIN