Provider Demographics
NPI:1669576682
Name:OSTERGARD, DONALD ROY (MD)
Entity type:Individual
Prefix:
First Name:DONALD
Middle Name:ROY
Last Name:OSTERGARD
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 1:3650 ATLANTIC AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90807-3418
Mailing Address - Country:US
Mailing Address - Phone:562-426-5630
Mailing Address - Fax:562-492-9893
Practice Address - Street 1:3650 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90807-3418
Practice Address - Country:US
Practice Address - Phone:562-426-5630
Practice Address - Fax:562-492-9893
Is Sole Proprietor?:No
Enumeration Date:2006-09-11
Last Update Date:2012-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA21175207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ82334ZOtherBLUE SHIELD
CAZZZ82334ZMedicaid
CA00A211750OtherBC PPIN
CAZZZ82334ZMedicaid
CAWA211756Medicare ID - Type UnspecifiedPPIN
CAW13235Medicare ID - Type UnspecifiedGROUP NUMBER
CAA22495Medicare UPIN