Provider Demographics
NPI:1396005211
Name:ITOH, AKINOBU (MD)
Entity type:Individual
Prefix:DR
First Name:AKINOBU
Middle Name:
Last Name:ITOH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:960 MASSACHUSETTS AVENUE
Mailing Address - Street 2:FL 2
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-2690
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:830 HARRISON AVENUE, STE 3400
Practice Address - Street 2:MOAKLEY BLDG.
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118-2905
Practice Address - Country:US
Practice Address - Phone:617-414-8060
Practice Address - Fax:617-414-8012
Is Sole Proprietor?:No
Enumeration Date:2012-05-24
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA290316208G00000X
MO2015041384208G00000X
RIMD18439208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110181787AMedicaid
NH3143903Medicaid
MO200002509Medicaid