Provider Demographics
NPI:1740506344
Name:OSBORNE, MARY KATHRYN (MD)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:KATHRYN
Last Name:OSBORNE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:42D MEDICAL GROUP
Mailing Address - Street 2:300 S. TWINING ST., BLDG 760
Mailing Address - City:APO
Mailing Address - State:AA
Mailing Address - Zip Code:36112
Mailing Address - Country:US
Mailing Address - Phone:334-953-5430
Mailing Address - Fax:334-953-5430
Practice Address - Street 1:34 3RD AVE # 171
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-5504
Practice Address - Country:US
Practice Address - Phone:844-384-2779
Practice Address - Fax:303-942-6679
Is Sole Proprietor?:No
Enumeration Date:2010-04-08
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101251169208D00000X
NY2984222084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice