Provider Demographics
NPI:1194832386
Name:BARRACK, ANDREA (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:
Last Name:BARRACK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1099 ALAKEA ST
Mailing Address - Street 2:SUITE 1100
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-4511
Mailing Address - Country:US
Mailing Address - Phone:808-547-4600
Mailing Address - Fax:808-547-4559
Practice Address - Street 1:599 FARRINGTON HWY
Practice Address - Street 2:SUITE 201
Practice Address - City:KAPOLEI
Practice Address - State:HI
Practice Address - Zip Code:96707-2001
Practice Address - Country:US
Practice Address - Phone:808-674-9500
Practice Address - Fax:808-674-9436
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2009-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD11787207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI53626101Medicaid
HI55479Medicare ID - Type Unspecified
HIH83904Medicare UPIN