Doctor Name: | MARY KATHRYN OSBORNE |
NPI Number: | 1740506344 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | M.D. |
License Number: | 0101251169 |
Business Practice Address: | 42d Medical Group 300 S. Twining St, Bldg 760 Maxwell Afb, AL - 36112 |
Business Phone Number: | 3349535430 |
Business Fax Number: | 3349535430 |
Mailing Address: | 42d Medical Group, 300 S. Twining St., Bldg 760 APO |
State: | AA |
Postal Code: | 36112 |
Phone Number: | 3349535430 |
Fax Number: | 3349535430 |
NPI Enumeration Date: | 04/08/2010 |
NPI Last Update Date: | 07/25/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | 0101251169 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | VA |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |