Individual
OSAMUDIAMEN IDAHOSA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D
Contact information
Practice address
801 OSTRUM ST, BETHLEHEM, PA 18015-1000
(484) 526-3285
Mailing address
211 CHESTNUT LN, NORTH WALES, PA 19454-1303
(267) 481-4905
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
MT183290
PA
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
Primary
MD432354
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0144436
—
NJ
01
—
1754246
AETNA - HMO
NJ
01
—
338072
AMERIGROUP
NJ
01
—
9031110
AENTA - PPO
NJ
01
—
91002708400
AMERICHOICE
NJ
01
—
P00620721
RR MEDICARE
NJ
Enumeration date
06/21/2007
Last updated
01/11/2023
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