Healthcare Provider Details

I. General information

NPI: 1952812265
Provider Name (Legal Business Name): DAVID OSBORNE HENRY MSPAS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/14/2017
Last Update Date: 07/26/2022
Certification Date: 07/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 E GERMANTOWN PIKE
EAST NORRITON PA
19401-6506
US

IV. Provider business mailing address

5000 COX RD
GLEN ALLEN VA
23060-9263
US

V. Phone/Fax

Practice location:
  • Phone: 610-994-0063
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberOA004304
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: