MEDICARE: HITOSHI HIROSE M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	MD425075	PA
2	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician	25MA10269800	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1235107467
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HITOSHI HIROSE M.D.

Provider Business Mailing Address
First Line	:	317 N BROAD ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19107-1014
Country	:	US
Telephone Number	:	215-925-4386
Fax Number	:

Provider Business Practice Location Address
First Line	:	1025 WALNUT ST RM 605
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19107-5001
Country	:	US
Telephone Number	:	215-518-4418
Fax Number	:	215-823-8222

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/14/2006
Last Update Date	:	01/31/2024

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