Provider Demographics
NPI:1679650410
Name:OSGANIAN, STAVROULA K (MD, SCD)
Entity Type:Individual
Prefix:DR
First Name:STAVROULA
Middle Name:K
Last Name:OSGANIAN
Suffix:
Gender:F
Credentials:MD, SCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:364 WORCESTER ST
Mailing Address - Street 2:
Mailing Address - City:SOUTHBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:01550-1328
Mailing Address - Country:US
Mailing Address - Phone:781-400-6920
Mailing Address - Fax:
Practice Address - Street 1:364 WORCESTER ST
Practice Address - Street 2:
Practice Address - City:SOUTHBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:01550-1328
Practice Address - Country:US
Practice Address - Phone:781-400-6920
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2019-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA584422083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2104806Medicaid
A38690Medicare ID - Type Unspecified