Provider Demographics
NPI:1164766259
Name:TSUTSUI, MASAHITO
Entity Type:Individual
Prefix:
First Name:MASAHITO
Middle Name:
Last Name:TSUTSUI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5511 BUTTERFLY LN APT 302
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27707-9074
Mailing Address - Country:US
Mailing Address - Phone:919-358-8460
Mailing Address - Fax:
Practice Address - Street 1:508 FULTON ST
Practice Address - Street 2:BLDG 15/RM 106
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-3875
Practice Address - Country:US
Practice Address - Phone:919-891-9001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-15
Last Update Date:2014-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program