MEDICARE: DR. MAKOTO IWAHARA 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	207R00000X	Internal Medicine Physician	147656	NY
2	207RG0100X	Gastroenterology Physician	147656	NY

General Provider Information

NPI Number	:	1366627143
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MAKOTO IWAHARA M.D.

Provider Business Mailing Address
First Line	:	120 E 79TH ST
Second Line	:	SUITE 1C
City	:	NEW YORK
State	:	NY
Zip	:	10075-0319
Country	:	US
Telephone Number	:	212-879-2328
Fax Number	:	212-879-1933

Provider Business Practice Location Address
First Line	:	120 E 79TH ST
Second Line	:	SUITE 1C
City	:	NEW YORK
State	:	NY
Zip	:	10075-0319
Country	:	US
Telephone Number	:	212-879-2328
Fax Number	:	212-879-1933

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

Provider Enumeration Date	:	12/30/2007
Last Update Date	:	04/18/2008

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