Provider Demographics
NPI:1407868391
Name:OKABE, ATSUKO (MD)
Entity Type:Individual
Prefix:
First Name:ATSUKO
Middle Name:
Last Name:OKABE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9101 FRANKLIN SQUARE DR
Mailing Address - Street 2:SUITE 110
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21237-3936
Mailing Address - Country:US
Mailing Address - Phone:443-777-6500
Mailing Address - Fax:443-777-6249
Practice Address - Street 1:9101 FRANKLIN SQUARE DR
Practice Address - Street 2:SUITE 110
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21237-3936
Practice Address - Country:US
Practice Address - Phone:443-777-6500
Practice Address - Fax:443-777-6249
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2008-12-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO32353208600000X
MDD0068149208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
C806856Medicare PIN
F48843Medicare UPIN