Provider Demographics
NPI:1386820363
Name:ITO, HIROHIKO (MD)
Entity Type:Individual
Prefix:
First Name:HIROHIKO
Middle Name:
Last Name:ITO
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 1:601 DODDS AVE
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37404-3911
Mailing Address - Country:JP
Mailing Address - Phone:866-730-5619
Mailing Address - Fax:423-698-3622
Practice Address - Street 1:386 OOAZA TAKAHATA
Practice Address - Street 2:
Practice Address - City:TAKAHATA
Practice Address - State:YAMAGATA
Practice Address - Zip Code:9920351
Practice Address - Country:JP
Practice Address - Phone:8123-852-1500
Practice Address - Fax:8123-852-1515
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-21
Last Update Date:2019-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.0775542085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102095991-0001Medicaid
PA2010543OtherHIGHMARK
OH4227011Medicare PIN
OH4227013Medicare PIN
OH4227014Medicare PIN
OH4227016Medicare PIN
PA109714Medicare PIN
OH4227012Medicare PIN
PA102095991-0001Medicaid