Provider Demographics
NPI:1619012457
Name:SATO, ALICE ISOME (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:ALICE
Middle Name:ISOME
Last Name:SATO
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 NEW SCOTLAND AVE # MC88
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12208-3795
Mailing Address - Country:US
Mailing Address - Phone:518-262-5332
Mailing Address - Fax:518-262-5301
Practice Address - Street 1:2055 N HIGH ST STE 190
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80205
Practice Address - Country:US
Practice Address - Phone:303-393-4300
Practice Address - Fax:303-832-7205
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2019-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07841100208000000X
CODR47250208000000X
PAMD420340208000000X
MDD59551208000000X
WAMD42069208000000X
OH35.0974682080P0208X
CODR.00472502080P0208X
NY2782472080P0208X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0208XAllopathic & Osteopathic PhysiciansPediatricsPediatric Infectious Diseases
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0055417Medicaid
WAAB32999OtherMEDICARE PTAN
CO07531885Medicaid