Provider Demographics
NPI:1538462569
Name:SASAKI, KOTARO (MD)
Entity Type:Individual
Prefix:DR
First Name:KOTARO
Middle Name:
Last Name:SASAKI
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 1:5030 CENTRE AVE
Mailing Address - Street 2:APT 361
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15213-1933
Mailing Address - Country:US
Mailing Address - Phone:412-606-5763
Mailing Address - Fax:
Practice Address - Street 1:A711 SCAIFE HL
Practice Address - Street 2:3550 TERRACE STREET
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15261-0001
Practice Address - Country:US
Practice Address - Phone:412-802-6013
Practice Address - Fax:412-802-6079
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-14
Last Update Date:2010-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT193660390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program