Healthcare Provider Details

I. General information

NPI: 1598788440
Provider Name (Legal Business Name): PEDIATRIC GROUP OF HONOLULU, LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1319 PUNAHOU ST SUITE 1100
HONOLULU HI
96826-1001
US

IV. Provider business mailing address

1319 PUNAHOU ST SUITE 1100
HONOLULU HI
96826-1001
US

V. Phone/Fax

Practice location:
  • Phone: 808-955-7845
  • Fax: 808-946-3071
Mailing address:
  • Phone: 808-955-7845
  • Fax: 808-946-3071

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: CAROL T HARTLEY
Title or Position: PARTNER
Credential: M.D.
Phone: 808-955-7845