Healthcare Provider Details

I. General information

NPI: 1033276209
Provider Name (Legal Business Name): MAGDY A METTIAS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2007
Last Update Date: 04/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

94-300 FARRINGTON HWY # E-06
WAIPAHU HI
96797-2648
US

IV. Provider business mailing address

94-300 FARRINGTON HWY # E-06
WAIPAHU HI
96797-2648
US

V. Phone/Fax

Practice location:
  • Phone: 808-671-1988
  • Fax: 808-677-0555
Mailing address:
  • Phone: 808-671-1988
  • Fax: 808-677-0555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD-7466
License Number StateHI
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberMD-7466
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: