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General NPI Number Information
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NPI Number | 1205840469
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Entity Type | Individual
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Provider Name | CHARLES THOMAS MAURO IV MD
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Gender | Male
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Dates
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Enumeration Date | 07/27/2006
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 868 ULULANI ST SUITE 103
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City | HILO
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State | HI
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Zip | 96720-3913
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Country | US
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Telephone | 808-961-3427
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Fax |
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Provider Business Mailing Address
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Address Line | 868 ULULANI ST SUITE 103
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City | HILO
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State | HI
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Zip | 96720-3913
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Country | US
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Telephone | 808-961-3427
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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 | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | MD12734
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License Number State | HI
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