Healthcare Provider Details

I. General information

NPI: 1366436024
Provider Name (Legal Business Name): MOHAMED B.S. OSMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2005
Last Update Date: 07/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

122 E BLUE ST
SAINT PAULS NC
28384-1812
US

IV. Provider business mailing address

PO BOX 9940
FAYETTEVILLE NC
28311-9094
US

V. Phone/Fax

Practice location:
  • Phone: 910-865-5177
  • Fax: 910-865-9400
Mailing address:
  • Phone: 910-865-5177
  • Fax: 910-865-9400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number200201142
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: