Healthcare Provider Details

I. General information

NPI: 1407868391
Provider Name (Legal Business Name): ATSUKO OKABE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2006
Last Update Date: 12/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9101 FRANKLIN SQUARE DR SUITE 110
BALTIMORE MD
21237-3936
US

IV. Provider business mailing address

9101 FRANKLIN SQUARE DR SUITE 110
BALTIMORE MD
21237-3936
US

V. Phone/Fax

Practice location:
  • Phone: 443-777-6500
  • Fax: 443-777-6249
Mailing address:
  • Phone: 443-777-6500
  • Fax: 443-777-6249

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number32353
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberD0068149
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: