Provider Demographics
NPI:1902875990
Name:FUKUCHI, STEVEN GITARO (MD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:GITARO
Last Name:FUKUCHI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:915 OLD FERN HILL RD
Mailing Address - Street 2:BUILDING B, SUITE 201
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19380-4269
Mailing Address - Country:US
Mailing Address - Phone:610-436-6696
Mailing Address - Fax:610-430-6023
Practice Address - Street 1:915 OLD FERN HILL RD
Practice Address - Street 2:BUILDING B, SUITE 201
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19380-4269
Practice Address - Country:US
Practice Address - Phone:610-436-6696
Practice Address - Fax:610-430-6023
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2022-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD067933L208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0019155260004Medicaid
PA0019155260004Medicaid
PA056912M10Medicare ID - Type Unspecified