Basic Information
Provider Information
NPI: 1245460302
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HIROOKA
FirstName: NOBUTAKA
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: M.D
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 200 LOTHROP ST
Address2: FORBES TOWER ROOM 9055
City: PITTSBURGH
State: PA
PostalCode: 152132536
CountryCode: US
TelephoneNumber: 4128028271
FaxNumber: 4126474486
Practice Location
Address1: 5215 CENTRE AVE
Address2:  
City: PITTSBURGH
State: PA
PostalCode: 152321303
CountryCode: US
TelephoneNumber: 4126232287
FaxNumber: 4126236629
Other Information
ProviderEnumerationDate: 07/22/2009
LastUpdateDate: 06/10/2010
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207Q00000XMD425266PAY Allopathic & Osteopathic PhysiciansFamily Medicine 

No ID Information.


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