1508898404 NPI number — DR. MAILA A COLEMAN MD

Table of content: DR. MAILA A COLEMAN MD (NPI 1508898404)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508898404 NPI number — DR. MAILA A COLEMAN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COLEMAN
Provider First Name:
MAILA
Provider Middle Name:
A
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1508898404
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/03/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 56
Provider Second Line Business Mailing Address:
8059 KEKAHA RD
Provider Business Mailing Address City Name:
KEKAHA
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96752-0056
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-517-5723
Provider Business Mailing Address Fax Number:
918-421-2938

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8059 KEKAHA RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KEKAHA
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96752
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-517-5723
Provider Business Practice Location Address Fax Number:
918-421-2938
Provider Enumeration Date:
07/07/2006

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:  MD-10629 , registered in the state of HI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208000000X , with the licence number: MD10629 , 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)

  • Identifier: 00D0216590 . This is a "HMSA" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".




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