Provider Demographics
NPI:1750346136
Name:OSMUN, ROGER WILLIAM (PHD)
Entity type:Individual
Prefix:DR
First Name:ROGER
Middle Name:WILLIAM
Last Name:OSMUN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1131 S SANATOGA RD
Mailing Address - Street 2:
Mailing Address - City:POTTSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19465-8167
Mailing Address - Country:US
Mailing Address - Phone:610-505-2494
Mailing Address - Fax:
Practice Address - Street 1:30 S VALLEY RD STE 306
Practice Address - Street 2:
Practice Address - City:PAOLI
Practice Address - State:PA
Practice Address - Zip Code:19301-1476
Practice Address - Country:US
Practice Address - Phone:610-536-6161
Practice Address - Fax:610-536-6161
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-19
Last Update Date:2018-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEB1-0000522103TC0700X
MD03880103TC0700X
PAPS008322L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01591123Medicaid
PA893132Medicare ID - Type Unspecified