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General NPI Number Information
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NPI Number | 1134626542
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Entity Type | Individual
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Provider Name | MARY THERESA CRAIG MD
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Gender | Female
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Dates
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Enumeration Date | 04/11/2018
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Last Update Date | 10/14/2024
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Provider Practice Location Address
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Address Line | 1319 PUNAHOU ST STE 1010
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City | HONOLULU
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State | HI
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Zip | 96826-1077
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Country | US
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Telephone | 808-763-2505
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Fax |
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Provider Business Mailing Address
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Address Line | 1319 PUNAHOU ST STE 1010
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City | HONOLULU
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State | HI
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Zip | 96826-1077
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Country | US
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Telephone | 808-763-2505
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Fax |
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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 | 2081P0010X
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Taxonomy Name | Pediatric Rehabilitation Medicine Physician
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License Number | MD-24412
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License Number State | HI
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