Provider Demographics
NPI:1700045416
Name:OSIPCHUK, OLEKSANDR (MD)
Entity Type:Individual
Prefix:
First Name:OLEKSANDR
Middle Name:
Last Name:OSIPCHUK
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 1:430 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:TN
Mailing Address - Zip Code:37087-3502
Mailing Address - Country:US
Mailing Address - Phone:615-444-3836
Mailing Address - Fax:615-552-0089
Practice Address - Street 1:430 W MAIN ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:TN
Practice Address - Zip Code:37087-3502
Practice Address - Country:US
Practice Address - Phone:615-444-3836
Practice Address - Fax:615-552-0089
Is Sole Proprietor?:No
Enumeration Date:2008-06-06
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA760562084P0800X
TN459372084P0800X
NY2516962084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1520006Medicaid
TN103I1266674Medicare PIN
NYJ400004066Medicare PIN