MEDICARE: MARY IRIS MEILY M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	8876	HI

General Provider Information

NPI Number	:	1407844905
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY IRIS MEILY M.D.

Provider Business Mailing Address
First Line	:	4300 WAIALAE AVE
Second Line	:
City	:	HONOLULU
State	:	HI
Zip	:	96816-5761
Country	:	US
Telephone Number	:	808-732-6259
Fax Number	:

Provider Business Practice Location Address
First Line	:	NAVAL MEDICAL CLINIC
Second Line	:	480 CENTRAL AVENUE
City	:	HONOLULU
State	:	HI
Zip	:	96860
Country	:	US
Telephone Number	:	808-473-1880
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/10/2005
Last Update Date	:	04/10/2025

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