Active NPI
Tomomi Mitsuzuka
- Family Medicine Physician
- Bethlehem, PA
National Provider Identifier
1558114025
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- MT230482
- Practice address
- 2830 Easton Ave
Bethlehem, PA 18017-4204 - Phone
- (484) 526-3555
- Fax
- (833) 822-5230
- NPI assigned
- Apr 8, 2024
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | MT230482 | PA | Primary |
Addresses
Primary practice location
2830 Easton Ave
Bethlehem, PA 18017-4204
Mailing address
1678 Cardinal Dr
Bethlehem, PA 18015-2332
Phone (610) 724-2430
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in PA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240510000210 | PA | Order and Referring Only - Family Practice | 2365883121 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MT230482 | PA | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1712534400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1712534400000",
"number": "1558114025",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1678 CARDINAL DR",
"city": "BETHLEHEM",
"state": "PA",
"postal_code": "180152332",
"telephone_number": "610-724-2430"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2830 EASTON AVE",
"city": "BETHLEHEM",
"state": "PA",
"postal_code": "180174204",
"telephone_number": "484-526-3555",
"fax_number": "833-822-5230"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MITSUZUKA",
"first_name": "TOMOMI",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2024-04-08",
"last_updated": "2024-04-08",
"certification_date": "2024-04-05",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "PA",
"license": "MT230482",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bethlehem, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.