Active NPI
Martha Iwamoto, M.D.
- Pediatrics Physician
- Bethel, AK
National Provider Identifier
1588845895
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 47454
- Practice address
- Yukon-Kuskokwim Health Corporation
Yukon-Kuskokwim Delta Regional Hospital
Bethel, AK 99559 - Phone
- (907) 543-0000
- NPI assigned
- Nov 15, 2007
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 47454 | GA | Primary |
Addresses
Primary practice location
Yukon-Kuskokwim Health Corporation
Yukon-Kuskokwim Delta Regional Hospital
Bethel, AK 99559
Mailing address
201 W Ponce de Leon Ave Unit 318
Decatur, GA 30030-3261
Phone (404) 639-4745
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 47454 | GA | MD | Pediatrics Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1195084800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1195084800000",
"number": "1588845895",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "201 W PONCE DE LEON AVE UNIT 318",
"city": "DECATUR",
"state": "GA",
"postal_code": "300303261",
"telephone_number": "404-639-4745",
"fax_number": "404-639-2205"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "YUKON-KUSKOKWIM HEALTH CORPORATION",
"address_2": "YUKON-KUSKOKWIM DELTA REGIONAL HOSPITAL",
"city": "BETHEL",
"state": "AK",
"postal_code": "99559",
"telephone_number": "907-543-0000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "IWAMOTO",
"first_name": "MARTHA",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-11-15",
"last_updated": "2007-11-15",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "GA",
"license": "47454",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bethel, AK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.