Provider Demographics
NPI:1114106036
Name:MCDONNELL, JOHN THOMAS (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:THOMAS
Last Name:MCDONNELL
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 1:46-001 KAMEHAMEHA HWY STE 401
Mailing Address - Street 2:
Mailing Address - City:KANEOHE
Mailing Address - State:HI
Mailing Address - Zip Code:96744-3788
Mailing Address - Country:US
Mailing Address - Phone:808-247-6070
Mailing Address - Fax:808-235-8928
Practice Address - Street 1:46-001 KAMEHAMEHA HWY STE 401
Practice Address - Street 2:
Practice Address - City:KANEOHE
Practice Address - State:HI
Practice Address - Zip Code:96744-3788
Practice Address - Country:US
Practice Address - Phone:808-247-6070
Practice Address - Fax:808-235-8928
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-26
Last Update Date:2008-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI3865207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI003310-01Medicaid
HIH0000BDHXFMedicare UPIN