Healthcare Provider Details

I. General information

NPI: 1750346136
Provider Name (Legal Business Name): ROGER WILLIAM OSMUN PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/19/2006
Last Update Date: 11/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 S VALLEY RD STE 306
PAOLI PA
19301-1476
US

IV. Provider business mailing address

1131 S SANATOGA RD
POTTSTOWN PA
19465-8167
US

V. Phone/Fax

Practice location:
  • Phone: 610-536-6161
  • Fax: 610-536-6161
Mailing address:
  • Phone: 610-505-2494
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberB1-0000522
License Number StateDE
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number03880
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPS008322L
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier01591123
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: