Provider Demographics
NPI:1366639429
Name:NISHINO HATABU, MIZUKI (MD)
Entity Type:Individual
Prefix:
First Name:MIZUKI
Middle Name:
Last Name:NISHINO HATABU
Suffix:
Gender:F
Credentials:MD
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:75 FRANCIS ST
Mailing Address - Street 2:RADIOLOGY, BRIGHAM AND WOMEN'S HOSPITAL
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115-6110
Mailing Address - Country:US
Mailing Address - Phone:617-667-3532
Mailing Address - Fax:617-525-7333
Practice Address - Street 1:75 FRANCIS ST
Practice Address - Street 2:RADIOLOGY, BRIGHAM AND WOMEN'S HOSPITAL
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-6110
Practice Address - Country:US
Practice Address - Phone:617-732-8098
Practice Address - Fax:617-525-7333
Is Sole Proprietor?:No
Enumeration Date:2007-10-02
Last Update Date:2012-09-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA2340702085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA000580101Medicare PIN