MEDICARE: DR. HIKARU ISIHARA M.D., PH.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	55750	MA

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

General Provider Information

NPI Number	:	1598750598
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HIKARU ISIHARA M.D., PH.D.

Provider Business Mailing Address
First Line	:	111 GROSSMAN DR
Second Line	:	HARVARD VANGUARD MEDICAL ASSOCIATES
City	:	BRAINTREE
State	:	MA
Zip	:	02184-4997
Country	:	US
Telephone Number	:	781-849-1000
Fax Number	:

Provider Business Practice Location Address
First Line	:	111 GROSSMAN DR
Second Line	:
City	:	BRAINTREE
State	:	MA
Zip	:	02184-4997
Country	:	US
Telephone Number	:	781-849-2241
Fax Number	:	781-849-2520

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

Provider Enumeration Date	:	09/15/2005
Last Update Date	:	07/12/2011

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