Healthcare Provider Details

I. General information

NPI: 1467985168
Provider Name (Legal Business Name): ALISON YUKIKO HARUTA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2017
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 SPRUCE STREET
PHILADELPHIA PA
19104-4238
US

IV. Provider business mailing address

3400 SPRUCE STREET
PHILADELPHIA PA
19104-4238
US

V. Phone/Fax

Practice location:
  • Phone: 215-662-7320
  • Fax: 215-349-5917
Mailing address:
  • Phone: 215-662-7320
  • Fax: 215-349-5917

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number073068
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number005909
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: