Provider Demographics
NPI:1598768103
Name:OSBORNE, TOMMY TAYLOR II (MD)
Entity Type:Individual
Prefix:DR
First Name:TOMMY
Middle Name:TAYLOR
Last Name:OSBORNE
Suffix:II
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 1:1701 CHURCH ST STE A
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23504-2304
Mailing Address - Country:US
Mailing Address - Phone:757-548-7190
Mailing Address - Fax:757-548-7191
Practice Address - Street 1:1701 CHURCH ST STE A
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23504-2304
Practice Address - Country:US
Practice Address - Phone:757-548-7190
Practice Address - Fax:757-548-7191
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101050384207XX0801X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XX0801XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Trauma
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA006402950Medicaid
VA6402950Medicaid
G96635Medicare UPIN
VA006402950Medicaid
VA00V040O95Medicare ID - Type Unspecified
VA4716690001Medicare NSC