MEDICARE: DR. TOMMY TAYLOR OSBORNE II MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207XX0801X	Orthopaedic Trauma Physician	0101050384	VA
2	207X00000X	Orthopaedic Surgery Physician	0101050384	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1598768103
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TOMMY TAYLOR OSBORNE II MD

Provider Business Mailing Address
First Line	:	1701 CHURCH ST STE A
Second Line	:
City	:	NORFOLK
State	:	VA
Zip	:	23504-2304
Country	:	US
Telephone Number	:	757-548-7190
Fax Number	:	757-548-7191

Provider Business Practice Location Address
First Line	:	1701 CHURCH ST STE A
Second Line	:
City	:	NORFOLK
State	:	VA
Zip	:	23504-2304
Country	:	US
Telephone Number	:	757-548-7190
Fax Number	:	757-548-7191

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/27/2005
Last Update Date	:	02/08/2022

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