Healthcare Provider Details

I. General information

NPI: 1619012457
Provider Name (Legal Business Name): ALICE ISOME SATO M.D., PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 02/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2055 N HIGH ST STE 190
DENVER CO
80205
US

IV. Provider business mailing address

22 NEW SCOTLAND AVE # MC88
ALBANY NY
12208-3795
US

V. Phone/Fax

Practice location:
  • Phone: 303-393-4300
  • Fax: 303-832-7205
Mailing address:
  • Phone: 518-262-5332
  • Fax: 518-262-5301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number25MA07841100
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberDR47250
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD420340
License Number StatePA
# 4
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD59551
License Number StateMD
# 5
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD42069
License Number StateWA
# 6
Primary TaxonomyN
Taxonomy Code2080P0208X
TaxonomyPediatric Infectious Diseases Physician
License Number35.097468
License Number StateOH
# 7
Primary TaxonomyN
Taxonomy Code2080P0208X
TaxonomyPediatric Infectious Diseases Physician
License NumberDR.0047250
License Number StateCO
# 8
Primary TaxonomyY
Taxonomy Code2080P0208X
TaxonomyPediatric Infectious Diseases Physician
License Number278247
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: