Basic Information
Provider Information
NPI: 1871914820
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: OSBORN
FirstName: TRUMAN
MiddleName: FORBES
NamePrefix: MR.
NameSuffix:  
Credential: PA-C
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: OSBORN
OtherFirstName: T.
OtherMiddleName: FORBES
OtherNamePrefix: MR.
OtherNameSuffix:  
OtherCredential: PA-C
OtherLastNameType: 5
Mailing Information
Address1: 100 E LANCASTER AVE
Address2: JD LANKENAU PAVILION, MEZZANINE
City: WYNNEWOOD
State: PA
PostalCode: 190963450
CountryCode: US
TelephoneNumber: 4844761000
FaxNumber: 4844769000
Practice Location
Address1: 100 E LANCASTER AVE
Address2: JD LANKENAU PAVILION, MEZZANINE
City: WYNNEWOOD
State: PA
PostalCode: 190963450
CountryCode: US
TelephoneNumber: 4844761000
FaxNumber: 4844769000
Other Information
ProviderEnumerationDate: 12/18/2013
LastUpdateDate: 10/19/2015
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363AS0400XMA000638LPAY Physician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical

No ID Information.


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