Marc Taro Ishizuka, D.O.

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

2012-01291 Issued in SC

Practice address

41 Park Creek Dr
VA Outpatient Clinic in Greenville
Greenville, SC 29605-4270

Phone

(864) 299-1600

NPI assigned

May 2, 2007

Last updated

Mar 24, 2017By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Columbia Vamc

  • Department of Veterans Affairs (VA) Pharmacy
  • Greenville, SC
  • NPI 1265490155
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1178064000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1490313600000",
    "number": "1023230844",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "41 PARK CREEK DR",
            "address_2": "VA OUTPATIENT CLINIC IN GREENVILLE",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296054270",
            "telephone_number": "864-299-1600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "41 PARK CREEK DR",
            "address_2": "VA OUTPATIENT CLINIC IN GREENVILLE",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296054270",
            "telephone_number": "864-299-1600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ISHIZUKA",
        "first_name": "MARC",
        "middle_name": "TARO",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-05-02",
        "last_updated": "2017-03-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "PA",
            "license": "OT010508",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NJ",
            "license": "25MB08244700",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "SC",
            "license": "2012-01291",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Briana Kyleen Isakson, PT
• Andrew James Isbell, DO
• Megan Emily Isenberg, PT
• Matthew David Isenhower
• Katheryn Dixon Isham, M.D.
• Lynn-Marly Isidore
• Rebecca Alsip Iskandar, D.O.
• Samy R Iskandar, MD
• Nurul Mohammed Islam, M.D.
• Mohammed A Ismail, BPHARM

• Psychiatry Physician in Greenville, SC
• Providers in Greenville, SC by specialty
• Psychiatry Physician in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.