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General NPI Number Information
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NPI Number | 1215138508
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Entity Type | Organization
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Legal Business Name | OSBORNE ORTHOPEDIC GROUP INC.
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Dates
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Enumeration Date | 05/31/2007
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Last Update Date | 11/20/2021
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Provider Practice Location Address
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Address Line | 1701 CHURCH ST STE A
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City | NORFOLK
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State | VA
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Zip | 23504-2304
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Country | US
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Telephone | 757-548-7190
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Fax | 757-548-7191
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Provider Business Mailing Address
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Address Line | 1701 CHURCH ST STE A
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City | NORFOLK
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State | VA
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Zip | 23504-2304
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Country | US
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Telephone | 757-548-7190
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Fax | 757-548-7191
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. TOMMY TAYLOR OSBORNE II
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Credential | MD
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Telephone | 757-777-4110
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 0101050384
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 0101050384
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License Number State | VA
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