Individual
DR. MAYUKO ITO FUKUNAGA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
55 LAKE AVE N, WORCESTER, MA 01655-0002
(508) 334-1975
Mailing address
PO BOX 415348, BOSTON, MA 02241-5348
(800) 225-8885
(508) 334-1977
Taxonomy
Speciality
Code
Description
License number
State
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
268768
MA
207RP1001X
Pulmonary Disease Physician
Primary
268768
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110118566A
—
MA
Enumeration date
05/23/2007
Last updated
06/07/2024
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