Provider Demographics
NPI:1881828457
Name:OSBORN, ELIZABETH RUTH (MD)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:RUTH
Last Name:OSBORN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:RUTH
Other - Last Name:GOETSCHIUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1991 BALSLEY RD
Mailing Address - Street 2:
Mailing Address - City:SENECA FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:13148
Mailing Address - Country:US
Mailing Address - Phone:315-539-9229
Mailing Address - Fax:315-539-0940
Practice Address - Street 1:1991 BALSLEY RD
Practice Address - Street 2:
Practice Address - City:SENECA FALLS
Practice Address - State:NY
Practice Address - Zip Code:13148
Practice Address - Country:US
Practice Address - Phone:315-539-9229
Practice Address - Fax:315-539-0940
Is Sole Proprietor?:No
Enumeration Date:2009-05-11
Last Update Date:2018-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY265963207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine