Provider Demographics
NPI:1386053437
Name:KOMATSU, ISSEI (MD)
Entity type:Individual
Prefix:
First Name:ISSEI
Middle Name:
Last Name:KOMATSU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 HOT METAL ST
Mailing Address - Street 2:QUANTUM ONE, SUITE 001
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15203-2348
Mailing Address - Country:US
Mailing Address - Phone:412-432-5869
Mailing Address - Fax:412-432-5640
Practice Address - Street 1:9104 BABCOCK BLVD
Practice Address - Street 2:SUITE 5113
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15237-5818
Practice Address - Country:US
Practice Address - Phone:412-748-7444
Practice Address - Fax:412-748-7452
Is Sole Proprietor?:No
Enumeration Date:2014-08-02
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD61134797207X00000X
PAMD451574207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA3086526OtherHIGHMARK
PA1029592230001Medicaid
PA1029592230001Medicaid