Provider Demographics
NPI:1720002405
Name:OSORNO, RICARDO J (MD)
Entity Type:Individual
Prefix:DR
First Name:RICARDO
Middle Name:J
Last Name:OSORNO
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 1:3708 MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:MD
Mailing Address - Zip Code:21122-2025
Mailing Address - Country:US
Mailing Address - Phone:410-255-1600
Mailing Address - Fax:410-255-7380
Practice Address - Street 1:3708 MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:MD
Practice Address - Zip Code:21122-2025
Practice Address - Country:US
Practice Address - Phone:410-255-1600
Practice Address - Fax:410-255-7380
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2016-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0045148207R00000X
FLME73687207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD15886130Medicaid
MDF78912Medicare UPIN
MD15886130Medicaid