MEDICARE: JONATHAN EDWARD OSBORN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1700384435
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JONATHAN EDWARD OSBORN

Provider Business Mailing Address
First Line	:	5 VALLEY VIEW DR
Second Line	:
City	:	VIENNA
State	:	WV
Zip	:	26105-3326
Country	:	US
Telephone Number	:	352-586-5913
Fax Number	:

Provider Business Practice Location Address
First Line	:	1775 N SECTOR CT
Second Line	:
City	:	WINCHESTER
State	:	VA
Zip	:	22601-2859
Country	:	US
Telephone Number	:	352-586-5913
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/29/2018
Last Update Date	:	01/29/2018

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Directions to “ JONATHAN EDWARD OSBORN ” Practice Location

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