1083677025 NPI number — CAROL HI'ILANI TITCOMB M.D.

Table of content: CAROL HI'ILANI TITCOMB M.D. (NPI 1083677025)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083677025 NPI number — CAROL HI'ILANI TITCOMB M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TITCOMB
Provider First Name:
CAROL
Provider Middle Name:
HI'ILANI
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HARTLEY
Provider Other First Name:
CAROL
Provider Other Middle Name:
TITCOMB
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1083677025
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/25/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
DESMOND DOSS HEALTH CLINIC
Provider Second Line Business Mailing Address:
680 MCCORNACK RD BUILDING B
Provider Business Mailing Address City Name:
SCHOFIELD BARRACKS
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96857
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-433-8382
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1319 PUNAHOU ST
Provider Second Line Business Practice Location Address:
SUITE 720
Provider Business Practice Location Address City Name:
HONOLULU
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96826-1001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-282-0943
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  MD8189 , registered in the state of HI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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