Healthcare Provider Details

I. General information

NPI: 1588707343
Provider Name (Legal Business Name): MILDRED BYNOE OSBORNE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MILLIE BYNOE OSBORNE M.D.

II. Dates (important events)

Enumeration Date: 02/14/2007
Last Update Date: 12/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3302 GALLOWS RD
FALLS CHURCH VA
22042-3353
US

IV. Provider business mailing address

3302 GALLOWS RD
FALLS CHURCH VA
22042-3353
US

V. Phone/Fax

Practice location:
  • Phone: 703-207-7100
  • Fax:
Mailing address:
  • Phone: 703-207-7100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number0101044394
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD037926
License Number StateDC
# 3
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number0101044394
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: