Provider Demographics
NPI:1558478800
Name:OSDER, JOAN (MD)
Entity Type:Individual
Prefix:DR
First Name:JOAN
Middle Name:
Last Name:OSDER
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 1:465 N ROXBURY DR STE 803
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-4211
Mailing Address - Country:US
Mailing Address - Phone:310-274-9954
Mailing Address - Fax:310-274-9450
Practice Address - Street 1:465 N ROXBURY DR STE 803
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-4211
Practice Address - Country:US
Practice Address - Phone:310-274-9954
Practice Address - Fax:310-274-9450
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-24
Last Update Date:2013-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG54798207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA954675063OtherTAX ID NUMBER
CA954675063OtherTAX ID NUMBER
CAG56106Medicare UPIN
CAG54798Medicare ID - Type Unspecified