Provider Demographics
NPI:1053413138
Name:OSMANSKA-JAC, DAGMARA (MD)
Entity type:Individual
Prefix:DR
First Name:DAGMARA
Middle Name:
Last Name:OSMANSKA-JAC
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 1:47 HIGH ST STE 101
Mailing Address - Street 2:
Mailing Address - City:NORTH ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01845-2662
Mailing Address - Country:US
Mailing Address - Phone:978-685-2460
Mailing Address - Fax:
Practice Address - Street 1:47 HIGH ST STE 101
Practice Address - Street 2:
Practice Address - City:NORTH ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01845-2662
Practice Address - Country:US
Practice Address - Phone:978-685-2460
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK1892207R00000X
MA238055207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110081539AMedicaid
MA110081539AMedicaid