Healthcare Provider Details

I. General information

NPI: 1427042860
Provider Name (Legal Business Name): LUIS A OSORIO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2005
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1445 WAMPANOAG TRL UNIT 205
RIVERSIDE RI
02915-1019
US

IV. Provider business mailing address

1445 WAMPANOAG TRL UNIT 205
RIVERSIDE RI
02915-1019
US

V. Phone/Fax

Practice location:
  • Phone: 401-388-3354
  • Fax:
Mailing address:
  • Phone: 401-388-3354
  • Fax: 401-710-8659

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD10536
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: