Provider Demographics
NPI:1003828815
Name:SUSSMAN, STEPHEN (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:
Last Name:SUSSMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2180 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WAILUKU
Mailing Address - State:HI
Mailing Address - Zip Code:96793-1666
Mailing Address - Country:US
Mailing Address - Phone:808-242-6464
Mailing Address - Fax:808-948-7438
Practice Address - Street 1:2180 MAIN ST
Practice Address - Street 2:
Practice Address - City:WAILUKU
Practice Address - State:HI
Practice Address - Zip Code:96793-1666
Practice Address - Country:US
Practice Address - Phone:808-242-6464
Practice Address - Fax:808-948-7438
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2010-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD11619207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI238378OtherHMSA, HMSA QUEST, 65CP
HI99017685996793B094OtherTRICARE CHAMPUS
HI515743OtherUHA
HIH54993Medicare PIN
HI99017685996793B094OtherTRICARE CHAMPUS
HI238378OtherHMSA, HMSA QUEST, 65CP