Provider Demographics
NPI:1639495955
Name:RICARDO J OSORNO MD LLC
Entity Type:Organization
Organization Name:RICARDO J OSORNO MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICARDO
Authorized Official - Middle Name:J
Authorized Official - Last Name:OSORNO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:442-926-2488
Mailing Address - Street 1:3708 MOUNTAIN RD
Mailing Address - Street 2:SUITE A1
Mailing Address - City:PASADENA
Mailing Address - State:MD
Mailing Address - Zip Code:21122-2025
Mailing Address - Country:US
Mailing Address - Phone:443-926-2488
Mailing Address - Fax:
Practice Address - Street 1:3708 MOUNTAIN RD
Practice Address - Street 2:SUITE A1
Practice Address - City:PASADENA
Practice Address - State:MD
Practice Address - Zip Code:21122-2025
Practice Address - Country:US
Practice Address - Phone:443-926-2488
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-12
Last Update Date:2010-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0045148207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDF78912Medicare UPIN