Healthcare Provider Details

I. General information

NPI: 1508815614
Provider Name (Legal Business Name): MARY LYNN FINES RICARDO-DUKELOW M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2006
Last Update Date: 11/23/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2424 KALAKAUA AVE # 476A
HONOLULU HI
96815-3233
US

IV. Provider business mailing address

98-1780 IPUALA LOOP
AIEA HI
96701-1701
US

V. Phone/Fax

Practice location:
  • Phone: 808-922-6000
  • Fax: 808-922-2680
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number23296
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number13253
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: