Healthcare Provider Details

I. General information

NPI: 1699772426
Provider Name (Legal Business Name): SATOSHI IKEDA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 PENNSYLVANIA AVE SUITE 3 D
WILMINGTON DE
19806-1392
US

IV. Provider business mailing address

2300 PENNSYLVANIA AVE SUITE 3 D
WILMINGTON DE
19806-1392
US

V. Phone/Fax

Practice location:
  • Phone: 302-656-3333
  • Fax: 302-656-1530
Mailing address:
  • Phone: 302-656-3333
  • Fax: 302-656-1530

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberC10000901
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: