Provider Demographics
NPI:1033206180
Name:GAYNOR, MARY KATHLEEN (MD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:KATHLEEN
Last Name:GAYNOR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:KATE
Other - Middle Name:
Other - Last Name:GAYNOR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:9 BLACK OAK DR
Mailing Address - Street 2:
Mailing Address - City:OCEAN VIEW
Mailing Address - State:NJ
Mailing Address - Zip Code:08230-1422
Mailing Address - Country:US
Mailing Address - Phone:206-227-9451
Mailing Address - Fax:
Practice Address - Street 1:1132 BISHOP ST
Practice Address - Street 2:SUITE 1900
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-2807
Practice Address - Country:US
Practice Address - Phone:808-587-5879
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD-13661207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H66133Medicare UPIN