Basic Information
| Provider Information | |||||||||
| NPI: | 1124036967 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SATO | ||||||||
| FirstName: | SUSUMU | ||||||||
| MiddleName: | - | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12213 RED CHURCH CT | ||||||||
| Address2: | |||||||||
| City: | POTOMAC | ||||||||
| State: | MD | ||||||||
| PostalCode: | 208542159 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3014965121 | ||||||||
| FaxNumber: | 3014028796 | ||||||||
| Practice Location | |||||||||
| Address1: | WALTER REED ARMY MEDICAL CENTER ATT MCHL-MAO-C | ||||||||
| Address2: | 6900 GEORGIA AVENUE, NW | ||||||||
| City: | WASHINGTON | ||||||||
| State: | DC | ||||||||
| PostalCode: | 203070001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2027827341 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/04/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171000000X | D0033408 | MD | Y | Other Service Providers | Military Health Care Provider |
No ID Information.