Healthcare Provider Details

I. General information

NPI: 1659346872
Provider Name (Legal Business Name): SUSAN P. OSBORNE, DO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2006
Last Update Date: 03/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

274 FLOYD HWY S STE 102
FLOYD VA
24091-2348
US

IV. Provider business mailing address

PO BOX 597
FLOYD VA
24091-0597
US

V. Phone/Fax

Practice location:
  • Phone: 540-745-6034
  • Fax: 540-745-6033
Mailing address:
  • Phone: 540-745-6034
  • Fax: 540-745-6033

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number0110840358
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904002196
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0102036909
License Number StateVA

VIII. Authorized Official

Name: DR. SUSAN PAGE OSBORNE
Title or Position: MEDICAL DIRECTOR
Credential: D.O.
Phone: 540-745-6034