Basic Information
Provider Information
NPI: 1164623930
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: OSMUN
FirstName: SCOTT
MiddleName: ANDREW KENNEDY
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 4001 BRANDYWINE ST NW
Address2: STE 300
City: WASHINGTON
State: DC
PostalCode: 200161876
CountryCode: US
TelephoneNumber: 2024499570
FaxNumber: 2024499513
Practice Location
Address1: 4001 BRANDYWINE ST NW STE 300
Address2:  
City: WASHINGTON
State: DC
PostalCode: 200161876
CountryCode: US
TelephoneNumber: 2024499570
FaxNumber: 2024499513
Other Information
ProviderEnumerationDate: 05/30/2007
LastUpdateDate: 03/26/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207V00000X0116015774VAY Allopathic & Osteopathic PhysiciansObstetrics & Gynecology 

No ID Information.


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