Healthcare Provider Details

I. General information

NPI: 1700059854
Provider Name (Legal Business Name): PETER MCNALLY MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2008
Last Update Date: 04/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1319 PUNAHOU ST STE 525
HONOLULU HI
96826-1073
US

IV. Provider business mailing address

PO BOX 25668
HONOLULU HI
96825-0668
US

V. Phone/Fax

Practice location:
  • Phone: 808-947-3122
  • Fax:
Mailing address:
  • Phone: 808-536-0300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number5442
License Number StateHI

VIII. Authorized Official

Name: PETER S MCNALLY
Title or Position: OWNER
Credential: MD
Phone: 808-947-3122