Provider Demographics
NPI:1811979479
Name:SASAMORI, TOSHIO (MD)
Entity type:Individual
Prefix:DR
First Name:TOSHIO
Middle Name:
Last Name:SASAMORI
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:PO BOX 303
Mailing Address - Street 2:
Mailing Address - City:STEVENSON
Mailing Address - State:MD
Mailing Address - Zip Code:21153-0303
Mailing Address - Country:US
Mailing Address - Phone:410-819-0710
Mailing Address - Fax:410-819-0712
Practice Address - Street 1:201 E UNIVERSITY PKWY
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21218-2829
Practice Address - Country:US
Practice Address - Phone:410-554-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2007-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0002535207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDP00260949OtherRR MEDICARE
MDM145Medicare PIN
MDP00260949OtherRR MEDICARE
MD893DMedicare ID - Type Unspecified