Provider Demographics
NPI:1831121342
Name:AKABANE, YOSHIHARU (MD)
Entity Type:Individual
Prefix:DR
First Name:YOSHIHARU
Middle Name:
Last Name:AKABANE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:YOSHIHARU
Other - Middle Name:
Other - Last Name:AKABANE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:330 LYNNWAY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LYNN
Mailing Address - State:MA
Mailing Address - Zip Code:01901
Mailing Address - Country:US
Mailing Address - Phone:781-595-6764
Mailing Address - Fax:781-593-0071
Practice Address - Street 1:330 LYNNWAY
Practice Address - Street 2:
Practice Address - City:LYNN
Practice Address - State:MA
Practice Address - Zip Code:01901
Practice Address - Country:US
Practice Address - Phone:781-595-6764
Practice Address - Fax:781-593-0071
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2011-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA402332084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0139017Medicaid
A55820Medicare UPIN
MAI20002AKMedicare ID - Type Unspecified