Provider Demographics
NPI:1558391946
Name:OSBORNE, RHONDA P (MD)
Entity Type:Individual
Prefix:
First Name:RHONDA
Middle Name:P
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 1:339 HICKS STREET (ATTN: MS. DONNETTE BENNETT)
Mailing Address - Street 2:SUNY DMC LICH RADIOLOGY
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201
Mailing Address - Country:US
Mailing Address - Phone:212-590-2930
Mailing Address - Fax:212-590-2982
Practice Address - Street 1:339 HICKS STREET
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201
Practice Address - Country:US
Practice Address - Phone:212-590-2930
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2013-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1782142085R0205X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0205XAllopathic & Osteopathic PhysiciansRadiologyRadiological Physics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01345720Medicaid
NY01345720Medicaid
NY35L181Medicare ID - Type Unspecified