Provider Demographics
NPI:1154442366
Name:OSIA, SISOM (MD)
Entity type:Individual
Prefix:DR
First Name:SISOM
Middle Name:
Last Name:OSIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2070
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20773-2070
Mailing Address - Country:US
Mailing Address - Phone:301-599-7010
Mailing Address - Fax:301-599-1222
Practice Address - Street 1:9628 MARLBORO PIKE
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20772
Practice Address - Country:US
Practice Address - Phone:301-599-7010
Practice Address - Fax:301-599-1222
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2010-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0048158207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD051701101Medicaid
00A877F07Medicare ID - Type Unspecified
MD051701101Medicaid