Provider Demographics
NPI:1881752442
Name:MITAMURA, JOHN (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:
Last Name:MITAMURA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:20 BEACON HILL DRIVE
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:DOBBS FERRY
Mailing Address - State:NY
Mailing Address - Zip Code:10522
Mailing Address - Country:US
Mailing Address - Phone:914-693-9400
Mailing Address - Fax:914-693-4793
Practice Address - Street 1:20 BEACON HILL DRIVE
Practice Address - Street 2:SUITE 2A
Practice Address - City:DOBBS FERRY
Practice Address - State:NY
Practice Address - Zip Code:10522
Practice Address - Country:US
Practice Address - Phone:914-693-9400
Practice Address - Fax:914-693-4793
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2008-04-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY160355207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
D91838Medicare UPIN
NY14F361Medicare PIN