Basic Information
| Provider Information | |||||||||
| NPI: | 1306034160 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SATOSHI IKEDA MD PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 71 OMEGA DR | ||||||||
| Address2: | BUILDING D | ||||||||
| City: | NEWARK | ||||||||
| State: | DE | ||||||||
| PostalCode: | 197132063 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3022833300 | ||||||||
| FaxNumber: | 3022833321 | ||||||||
| Practice Location | |||||||||
| Address1: | 111 W HIGH ST | ||||||||
| Address2: | SUITE 211 | ||||||||
| City: | ELKTON | ||||||||
| State: | MD | ||||||||
| PostalCode: | 219215529 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4103923033 | ||||||||
| FaxNumber: | 4103922897 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/05/2007 | ||||||||
| LastUpdateDate: | 10/24/2008 | ||||||||
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| AuthorizedOfficialLastName: | IKEDA | ||||||||
| AuthorizedOfficialFirstName: | SATOSHI | ||||||||
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| AuthorizedOfficialTitleorPosition: | DOCTOR | ||||||||
| AuthorizedOfficialTelephone: | 4103923033 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208G00000X | C100000901 | DE | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Thoracic Surgery (Cardiothoracic Vascular Surgery) |
ID Information
| ID | Type | State | Issuer | Description | 170001 | 05 | MD | MEDICAID |