Provider Demographics
NPI:1700947603
Name:OSBORN, MARK W (DO)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:W
Last Name:OSBORN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:500 CARR 177
Mailing Address - Street 2:BOX #3
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00959-8913
Mailing Address - Country:US
Mailing Address - Phone:787-729-2305
Mailing Address - Fax:
Practice Address - Street 1:COMDT CG-1122
Practice Address - Street 2:US COAST GUARD 2100 2ND. ST. SW SUITE 5314
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20593-0001
Practice Address - Country:US
Practice Address - Phone:202-475-5180
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102201429207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine