Provider Demographics
NPI:1598945495
Name:OSBOURNE, TANISHA M (MD)
Entity type:Individual
Prefix:
First Name:TANISHA
Middle Name:M
Last Name:OSBOURNE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7211 BANK CT
Mailing Address - Street 2:SUITE 200
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21703-8483
Mailing Address - Country:US
Mailing Address - Phone:240-457-4605
Mailing Address - Fax:240-457-4631
Practice Address - Street 1:7211 BANK CT
Practice Address - Street 2:SUITE 200
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21703-8483
Practice Address - Country:US
Practice Address - Phone:240-457-4605
Practice Address - Fax:240-457-4631
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-07
Last Update Date:2012-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
282N00000X
MDD0074566174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No282N00000XHospitalsGeneral Acute Care HospitalGroup - Multi-Specialty