MEDICARE: DR. MARCEY OSGOOD D.O.

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	2084A2900X	Neurocritical Care Physician	266365	MA
2	2084N0400X	Neurology Physician	245187	MA
3	207R00000X	Internal Medicine Physician	245187	MA
4	2084N0400X	Neurology Physician	34011364	OH
5	2084N0400X	Neurology Physician	266365	MA

General Provider Information

NPI Number	:	1770894107
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARCEY OSGOOD D.O.

Provider Business Mailing Address
First Line	:	PO BOX 415348
Second Line	:
City	:	BOSTON
State	:	MA
Zip	:	02241-5348
Country	:	US
Telephone Number	:	508-561-8116
Fax Number	:

Provider Business Practice Location Address
First Line	:	55 LAKE AVE N
Second Line	:
City	:	WORCESTER
State	:	MA
Zip	:	01655-0002
Country	:	US
Telephone Number	:	508-334-2527
Fax Number	:	508-856-3160

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

Provider Enumeration Date	:	06/30/2010
Last Update Date	:	10/25/2022

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