Basic Information
| Provider Information | |||||||||
| NPI: | 1477658730 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | OSPINA | ||||||||
| FirstName: | RICHARD | ||||||||
| MiddleName: | |||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 79429 | ||||||||
| Address2: | |||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212790429 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3016245730 | ||||||||
| FaxNumber: | 3016245731 | ||||||||
| Practice Location | |||||||||
| Address1: | 1500 N BEAUREGARD ST STE 300 | ||||||||
| Address2: | |||||||||
| City: | ALEXANDRIA | ||||||||
| State: | VA | ||||||||
| PostalCode: | 223111715 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7038451500 | ||||||||
| FaxNumber: | 7038451300 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/13/2006 | ||||||||
| LastUpdateDate: | 10/21/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/21/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084N0400X | 0101234390 | VA | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology |
ID Information
| ID | Type | State | Issuer | Description | 7997474 | 01 | VA | AETNA | OTHER | 1505687000 | 01 | DC | US DEPT OF LABOR W/C | OTHER | 289049 | 01 | VA | ANTHEM | OTHER | 283597 | 01 | VA | AMERIGROUP | OTHER | 612326 | 01 | VA | NCPPO | OTHER | P00030237 | 01 | VA | RAILROAD MEDICARE | OTHER | 2105516 | 01 | VA | ALLIANCE/MAMSI | OTHER | 007119453 | 05 | VA | MEDICAID | 4571 0006 | 01 | DC | CF BC BS DC | OTHER | 2281433 | 01 | VA | UNITED HEALTHCARE | OTHER |