Provider Demographics
NPI:1619131968
Name:AL-AGHA, OSAMA M (MD)
Entity Type:Individual
Prefix:DR
First Name:OSAMA
Middle Name:M
Last Name:AL-AGHA
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 1:181 ALLEN ST
Mailing Address - Street 2:APT 2
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14201-1515
Mailing Address - Country:US
Mailing Address - Phone:646-339-7483
Mailing Address - Fax:
Practice Address - Street 1:ROSWELL PARK CANCER INSTITUTE PATHOLOGY DEPT
Practice Address - Street 2:ELM 7 CARLTON STREETS
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14263-0001
Practice Address - Country:US
Practice Address - Phone:716-845-7700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-16
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP62124284300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes284300000XHospitalsSpecial Hospital