Provider Demographics
NPI:1578597712
Name:MORIKAWA, MASAHIRO (MD)
Entity Type:Individual
Prefix:
First Name:MASAHIRO
Middle Name:
Last Name:MORIKAWA
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:PO BOX 9007
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22906-9007
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1221 LEE ST
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22908-1716
Practice Address - Country:US
Practice Address - Phone:434-924-5348
Practice Address - Fax:434-924-8335
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101266161207Q00000X
OH35-070647207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1578597712Medicaid
OH2111342Medicaid
363859OtherWELLCARE
000000224235OtherUNISON
OH2059173OtherAETNA
737692OtherBUCKEYE
OH000000530396OtherANTHEM
VA1578597712Medicaid
OH80145552OtherRAILROAD MEDICARE
OH000000530396OtherANTHEM
363859OtherWELLCARE
OH2111342Medicaid