Provider Demographics
NPI:1164506549
Name:CARLILE, GLORIA N
Entity Type:Individual
Prefix:
First Name:GLORIA
Middle Name:N
Last Name:CARLILE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:970 NORTH KALAHEO AVE
Mailing Address - Street 2:C103
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734
Mailing Address - Country:US
Mailing Address - Phone:808-254-6474
Mailing Address - Fax:808-254-6400
Practice Address - Street 1:970 NORTH KALAHEO AVE
Practice Address - Street 2:C103
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734
Practice Address - Country:US
Practice Address - Phone:808-254-6474
Practice Address - Fax:808-254-6400
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD5564208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics