Basic Information
| Provider Information | |||||||||
| NPI: | 1386053437 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KOMATSU | ||||||||
| FirstName: | ISSEI | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2 HOT METAL ST | ||||||||
| Address2: | QUANTUM ONE, SUITE 001 | ||||||||
| City: | PITTSBURGH | ||||||||
| State: | PA | ||||||||
| PostalCode: | 152032348 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4124325869 | ||||||||
| FaxNumber: | 4124325640 | ||||||||
| Practice Location | |||||||||
| Address1: | 9104 BABCOCK BLVD | ||||||||
| Address2: | SUITE 5113 | ||||||||
| City: | PITTSBURGH | ||||||||
| State: | PA | ||||||||
| PostalCode: | 152375818 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4127487444 | ||||||||
| FaxNumber: | 4127487452 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/02/2014 | ||||||||
| LastUpdateDate: | 08/19/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/19/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | MD61134797 | WA | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207X00000X | MD451574 | PA | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 3086526 | 01 | PA | HIGHMARK | OTHER | 1029592230001 | 05 | PA | MEDICAID |