Provider Demographics
NPI:1023252715
Name:OSBORN, RACHEL R (MD)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:R
Last Name:OSBORN
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 1:333 CEDAR ST # 4100
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06510-3206
Mailing Address - Country:US
Mailing Address - Phone:203-785-6668
Mailing Address - Fax:
Practice Address - Street 1:1 PARK STREET
Practice Address - Street 2:SOUTH PAVILLION 7TH FLOOR - 74
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06504-8901
Practice Address - Country:US
Practice Address - Phone:203-688-4242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-24
Last Update Date:2019-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT51970207R00000X, 208000000X
MI4301112464207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1186696OtherUSA
CT4936547OtherAETNA
CT010051970CT02OtherANTHEM BCBS CT
CT051970OtherCONNECTICARE
CTD400089901OtherRR MEDICARE
CT1186696OtherUSA