Provider Demographics
NPI:1871896597
Name:ESSA, OSAMA (MD)
Entity type:Individual
Prefix:DR
First Name:OSAMA
Middle Name:
Last Name:ESSA
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 1:105 COUNTY ROUTE 45A STE 100
Mailing Address - Street 2:
Mailing Address - City:OSWEGO
Mailing Address - State:NY
Mailing Address - Zip Code:13126-6665
Mailing Address - Country:US
Mailing Address - Phone:315-342-6771
Mailing Address - Fax:315-342-2842
Practice Address - Street 1:105 COUNTY ROUTE 45A STE 100
Practice Address - Street 2:
Practice Address - City:OSWEGO
Practice Address - State:NY
Practice Address - Zip Code:13126-6665
Practice Address - Country:US
Practice Address - Phone:315-342-6771
Practice Address - Fax:315-342-2842
Is Sole Proprietor?:No
Enumeration Date:2010-12-20
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY295284208600000X
PAMD453899208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery