Basic Information
| Provider Information | |||||||||
| NPI: | 1285253104 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MITSUHASHI | ||||||||
| FirstName: | SHUJI | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 833 CHESTNUT ST STE 220 | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191074405 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2159558465 | ||||||||
| FaxNumber: | 2159552516 | ||||||||
| Practice Location | |||||||||
| Address1: | 833 CHESTNUT ST STE 220 | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191074405 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2159558465 | ||||||||
| FaxNumber: | 2159552516 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/10/2020 | ||||||||
| LastUpdateDate: | 06/03/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 06/03/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | STUDENT | PA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | MT221248 | PA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.