Provider Demographics
NPI:1972575454
Name:ONISHI, NORIHITO (DO)
Entity type:Individual
Prefix:DR
First Name:NORIHITO
Middle Name:
Last Name:ONISHI
Suffix:
Gender:M
Credentials:DO
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 378
Mailing Address - Street 2:
Mailing Address - City:MT MORRIS
Mailing Address - State:PA
Mailing Address - Zip Code:15349
Mailing Address - Country:US
Mailing Address - Phone:888-262-0021
Mailing Address - Fax:724-324-5436
Practice Address - Street 1:186 LOCUST AVE
Practice Address - Street 2:
Practice Address - City:MT MORRIS
Practice Address - State:PA
Practice Address - Zip Code:15349
Practice Address - Country:US
Practice Address - Phone:888-262-0021
Practice Address - Fax:724-324-5436
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-07
Last Update Date:2014-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1822207Q00000X
PA05015849207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVP00264136OtherRR MEDICARE
WV3004546000Medicaid
WV7930526OtherAETNA
WV001720362OtherMS BCBS
WV001720362OtherMS BCBS
H66475Medicare UPIN
WV2029291Medicare PIN
WV2029294Medicare PIN
WVH66475Medicare UPIN
WV3004546000Medicaid