Provider Demographics
NPI:1639494057
Name:OSIAN-DUGAN, EWERE O (MD)
Entity Type:Individual
Prefix:
First Name:EWERE
Middle Name:O
Last Name:OSIAN-DUGAN
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 1:725 FALLSWAY
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21202-4147
Mailing Address - Country:US
Mailing Address - Phone:667-600-3429
Mailing Address - Fax:667-600-4092
Practice Address - Street 1:725 FALLSWAY
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21202-4147
Practice Address - Country:US
Practice Address - Phone:667-600-3429
Practice Address - Fax:667-600-4092
Is Sole Proprietor?:No
Enumeration Date:2010-03-29
Last Update Date:2018-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD779812084P0802X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD741505200Medicaid