1548326754 NPI number — DR. DAVID ANDREW WOLKOFF M.D.

Table of content: SAMANTHA PREWETT (NPI 1780326660)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548326754 NPI number — DR. DAVID ANDREW WOLKOFF M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WOLKOFF
Provider First Name:
DAVID
Provider Middle Name:
ANDREW
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

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:
1548326754
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
91-2301 FORT WEAVER RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EWA BEACH
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96706-3602
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-671-8511
Provider Business Mailing Address Fax Number:
808-677-2574

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
91-2301 FORT WEAVER RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EWA BEACH
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96706-3602
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-671-8511
Provider Business Practice Location Address Fax Number:
808-677-2574
Provider Enumeration Date:
12/29/2006

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: 2084P0800X , with the licence number:  MD10028 , 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: MD10028 . This is a "MDX HAWAII" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: 495897-01 , issued by the state of ( HI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 990298651-96706-E055 . This is a "TRICARE" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: 0000231746 . This is a "HMSA" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: 04958973 . This is a "ALOHACARE" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: 0000231746 . This is a "HMSA-QUEST" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: 073261 . This is a "UNIVERSITY HEALTH ALLIANC" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".




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