Provider Demographics
NPI:1780797019
Name:OSTRUP, RICHARD (MD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:
Last Name:OSTRUP
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3750 CONVOY ST STE 301
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92111-3741
Mailing Address - Country:US
Mailing Address - Phone:619-297-4481
Mailing Address - Fax:858-810-7307
Practice Address - Street 1:3750 CONVOY ST STE 301
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92111-3741
Practice Address - Country:US
Practice Address - Phone:619-297-4481
Practice Address - Fax:619-291-5536
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG44778207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA49748Medicare UPIN
CAWG44778BMedicare PIN
CAWG44778FMedicare PIN