MEDICARE: MARY DIANE ECKERT MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	219521	NY
2	2084P0804X	Child & Adolescent Psychiatry Physician	16081	HI

General Provider Information

NPI Number	:	1548326523
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY DIANE ECKERT MD

Provider Business Mailing Address
First Line	:	1356 LUSITANA ST
Second Line	:	PSYCHIATRY DEPT 4TH FLOOR
City	:	HONOLULU
State	:	HI
Zip	:	96813-2409
Country	:	US
Telephone Number	:	808-586-2900
Fax Number	:	808-586-2940

Provider Business Practice Location Address
First Line	:	1356 LUSITANA ST
Second Line	:	PSYCHIATRY DEPT 4TH FLOOR
City	:	HONOLULU
State	:	HI
Zip	:	96813-2409
Country	:	US
Telephone Number	:	808-586-2900
Fax Number	:	808-586-2940

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/28/2006
Last Update Date	:	03/24/2016

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