Provider Demographics
NPI:1831233444
Name:KUSAKABE, ALAN O (MD)
Entity type:Individual
Prefix:DR
First Name:ALAN
Middle Name:O
Last Name:KUSAKABE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:301 SAINT PAUL PL
Mailing Address - Street 2:P.O.B. 802
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21202-2102
Mailing Address - Country:US
Mailing Address - Phone:410-332-9654
Mailing Address - Fax:410-685-8975
Practice Address - Street 1:301 SAINT PAUL PL
Practice Address - Street 2:P.O.B. 802
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21202-2102
Practice Address - Country:US
Practice Address - Phone:410-332-9654
Practice Address - Fax:410-685-8975
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-16
Last Update Date:2009-07-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
390200000X
MDD0068902208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program