Provider Demographics
NPI:1942503628
Name:OSTERMAN, DEANN L (PA)
Entity Type:Individual
Prefix:
First Name:DEANN
Middle Name:L
Last Name:OSTERMAN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3006 N COUNTY ROAD 25A
Mailing Address - Street 2:STE 104
Mailing Address - City:TROY
Mailing Address - State:OH
Mailing Address - Zip Code:45373-1373
Mailing Address - Country:US
Mailing Address - Phone:937-335-3518
Mailing Address - Fax:937-332-6857
Practice Address - Street 1:3006 N COUNTY ROAD 25A
Practice Address - Street 2:STE 104
Practice Address - City:TROY
Practice Address - State:OH
Practice Address - Zip Code:45373-1373
Practice Address - Country:US
Practice Address - Phone:937-335-3518
Practice Address - Fax:937-332-6857
Is Sole Proprietor?:No
Enumeration Date:2010-12-17
Last Update Date:2013-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.004989363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0067871Medicaid
OHPA37531Medicare PIN
OH0067871Medicaid