Provider Demographics
NPI:1306034160
Name:SATOSHI IKEDA MD PA
Entity Type:Organization
Organization Name:SATOSHI IKEDA MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SATOSHI
Authorized Official - Middle Name:
Authorized Official - Last Name:IKEDA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-392-3033
Mailing Address - Street 1:71 OMEGA DR
Mailing Address - Street 2:BUILDING D
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-2063
Mailing Address - Country:US
Mailing Address - Phone:302-283-3300
Mailing Address - Fax:302-283-3321
Practice Address - Street 1:111 W HIGH ST
Practice Address - Street 2:SUITE 211
Practice Address - City:ELKTON
Practice Address - State:MD
Practice Address - Zip Code:21921-5529
Practice Address - Country:US
Practice Address - Phone:410-392-3033
Practice Address - Fax:410-392-2897
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-05
Last Update Date:2008-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC100000901208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD170001Medicaid
MD170001Medicaid
MD079MMedicare PIN