Provider Demographics
NPI:1043304900
Name:MARC B. SHLACHTER, M.D., INC.
Entity Type:Organization
Organization Name:MARC B. SHLACHTER, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/MD
Authorized Official - Prefix:
Authorized Official - First Name:MARC
Authorized Official - Middle Name:BRIAN
Authorized Official - Last Name:SHLACHTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-293-8558
Mailing Address - Street 1:55-510 KAMEHAMEHA HWY
Mailing Address - Street 2:
Mailing Address - City:LAIE
Mailing Address - State:HI
Mailing Address - Zip Code:96762-1138
Mailing Address - Country:US
Mailing Address - Phone:808-293-8558
Mailing Address - Fax:808-293-2573
Practice Address - Street 1:55-510 KAMEHAMEHA HWY
Practice Address - Street 2:
Practice Address - City:LAIE
Practice Address - State:HI
Practice Address - Zip Code:96762-1138
Practice Address - Country:US
Practice Address - Phone:808-293-8558
Practice Address - Fax:808-293-2573
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2008-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIHSHLACHTERMedicare PIN