Provider Demographics
NPI:1124036967
Name:SATO, SUSUMU - (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSUMU
Middle Name:-
Last Name:SATO
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 1:12213 RED CHURCH CT
Mailing Address - Street 2:
Mailing Address - City:POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20854-2159
Mailing Address - Country:US
Mailing Address - Phone:301-496-5121
Mailing Address - Fax:301-402-8796
Practice Address - Street 1:WALTER REED ARMY MEDICAL CENTER ATT MCHL-MAO-C
Practice Address - Street 2:6900 GEORGIA AVENUE, NW
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20307-0001
Practice Address - Country:US
Practice Address - Phone:202-782-7341
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0033408171000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171000000XOther Service ProvidersMilitary Health Care Provider