Provider Demographics
NPI:1902962822
Name:OSBORNE, LADD BRUCE (MD)
Entity Type:Individual
Prefix:DR
First Name:LADD
Middle Name:BRUCE
Last Name:OSBORNE
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 668
Mailing Address - Street 2:202 RIVER RD
Mailing Address - City:PERU
Mailing Address - State:NY
Mailing Address - Zip Code:12972-0668
Mailing Address - Country:US
Mailing Address - Phone:518-643-2239
Mailing Address - Fax:
Practice Address - Street 1:CVPH MEDICAL CTR
Practice Address - Street 2:75 BEEKMAN ST
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12901
Practice Address - Country:US
Practice Address - Phone:518-562-7370
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY177021207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine