Basic Information
| Provider Information | |||||||||
| NPI: | 1023252715 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | OSBORN | ||||||||
| FirstName: | RACHEL | ||||||||
| MiddleName: | R | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 333 CEDAR ST # 4100 | ||||||||
| Address2: | |||||||||
| City: | NEW HAVEN | ||||||||
| State: | CT | ||||||||
| PostalCode: | 065103206 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2037856668 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1 PARK STREET | ||||||||
| Address2: | SOUTH PAVILLION 7TH FLOOR - 74 | ||||||||
| City: | NEW HAVEN | ||||||||
| State: | CT | ||||||||
| PostalCode: | 065048901 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2036884242 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/24/2009 | ||||||||
| LastUpdateDate: | 06/17/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 51970 | CT | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 4301112464 | MI | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208000000X | 51970 | CT | N | Allopathic & Osteopathic Physicians | Pediatrics | 208000000X | 4301112464 | MI | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 1186696 | 01 | CT | USA | OTHER | 4936547 | 01 | CT | AETNA | OTHER | 010051970CT02 | 01 | CT | ANTHEM BCBS CT | OTHER | 051970 | 01 | CT | CONNECTICARE | OTHER | D400089901 | 01 | CT | RR MEDICARE | OTHER |