Provider Demographics
NPI:1780628404
Name:OSMAN, MAGDI H (MD)
Entity type:Individual
Prefix:DR
First Name:MAGDI
Middle Name:H
Last Name:OSMAN
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 1:208 ELIOT ST
Mailing Address - Street 2:
Mailing Address - City:NATICK
Mailing Address - State:MA
Mailing Address - Zip Code:01760
Mailing Address - Country:US
Mailing Address - Phone:508-653-0083
Mailing Address - Fax:
Practice Address - Street 1:4 ORR SQ
Practice Address - Street 2:
Practice Address - City:REVERE
Practice Address - State:MA
Practice Address - Zip Code:02151-3216
Practice Address - Country:US
Practice Address - Phone:781-284-4700
Practice Address - Fax:781-284-8745
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-15
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA72135207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3058115Medicaid
E42687Medicare UPIN
MAJO9580Medicare ID - Type Unspecified