Provider Demographics
NPI:1083649982
Name:ALTAHA, RAMIN (MD)
Entity Type:Individual
Prefix:DR
First Name:RAMIN
Middle Name:
Last Name:ALTAHA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:24 NORTH CHURCH STREET
Mailing Address - Street 2:SUITE 308
Mailing Address - City:WAILUKU
Mailing Address - State:HI
Mailing Address - Zip Code:96793
Mailing Address - Country:US
Mailing Address - Phone:808-242-1110
Mailing Address - Fax:855-839-9759
Practice Address - Street 1:24 NORTH CHURCH STREET
Practice Address - Street 2:SUITE 308
Practice Address - City:WAILUKU
Practice Address - State:HI
Practice Address - Zip Code:96793
Practice Address - Country:US
Practice Address - Phone:808-242-1110
Practice Address - Fax:855-839-9759
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2015-12-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
HIMD-16120207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
I06456Medicare UPIN
WVAL4133011Medicare ID - Type Unspecified
WV3810000219Medicaid