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General NPI Number Information
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NPI Number | 1134165301
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Entity Type | Individual
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Provider Name | ELIOT A. DEMELLO MD
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Gender | Male
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Dates
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Enumeration Date | 06/22/2006
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Last Update Date | 07/02/2015
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Provider Practice Location Address
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Address Line | 4643 WAIMEA CANYON RD
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City | WAIMEA
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State | HI
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Zip | 96796
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Country | US
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Telephone | 904-805-1300
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Fax | 904-805-1302
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Provider Business Mailing Address
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Address Line | PO BOX 869
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City | WAIANAE
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State | HI
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Zip | 96792-0869
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Country | US
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Telephone | 904-805-1300
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Fax | 904-805-1302
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | MD4005
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License Number State | HI
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Taxonomy #2
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | MD-4005
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License Number State | HI
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