Provider Demographics
NPI:1265473045
Name:TAKEBE, NAOKO (MD PHD)
Entity Type:Individual
Prefix:DR
First Name:NAOKO
Middle Name:
Last Name:TAKEBE
Suffix:
Gender:F
Credentials:MD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9609 MEDICAL CENTER DR
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-3330
Mailing Address - Country:US
Mailing Address - Phone:240-276-6565
Mailing Address - Fax:240-276-7894
Practice Address - Street 1:9609 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-3330
Practice Address - Country:US
Practice Address - Phone:240-276-6565
Practice Address - Fax:240-276-7894
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2015-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD55341207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD052101900Medicaid
MD775ZMedicare PIN
H07238Medicare UPIN
MD110194338Medicare PIN