Provider Demographics
NPI:1346230273
Name:BESSINGER, GLENN TODD (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:GLENN
Middle Name:TODD
Last Name:BESSINGER
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1029 KAPAHULU AVE
Mailing Address - Street 2:SUITE 503
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96816-1332
Mailing Address - Country:US
Mailing Address - Phone:808-218-7889
Mailing Address - Fax:808-218-7891
Practice Address - Street 1:970 N KALAHEO AVE STE C108
Practice Address - Street 2:
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-1871
Practice Address - Country:US
Practice Address - Phone:808-218-7889
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-22
Last Update Date:2019-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD31931207N00000X
WY8214A207N00000X
HIMD13649207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology