Healthcare Provider Details

I. General information

NPI: 1831169432
Provider Name (Legal Business Name): COLLINS O. OSULA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2006
Last Update Date: 02/20/2024
Certification Date: 01/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 SHERMAN ST
JAMESTOWN NY
14701-7080
US

IV. Provider business mailing address

207 FOOTE AVE OB/GYN
JAMESTOWN NY
14701-7077
US

V. Phone/Fax

Practice location:
  • Phone: 716-393-0113
  • Fax:
Mailing address:
  • Phone: 716-393-0113
  • Fax: 716-366-5224

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number2103921
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: