Provider Demographics
NPI:1366476376
Name:BHATTACHARYYA, EESHA R (MD)
Entity Type:Individual
Prefix:
First Name:EESHA
Middle Name:R
Last Name:BHATTACHARYYA
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 1:642 ULUKAHIKI ST
Mailing Address - Street 2:STE 209
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-4400
Mailing Address - Country:US
Mailing Address - Phone:808-230-8500
Mailing Address - Fax:808-230-8501
Practice Address - Street 1:642 ULUKAHIKI ST
Practice Address - Street 2:STE 209
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-4400
Practice Address - Country:US
Practice Address - Phone:808-230-8500
Practice Address - Fax:808-230-8501
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2021-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD6989207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI1285965822OtherNOMORECLIPBOARD
HI94359OtherHMSA
HI072533Medicaid
HI1285965822OtherNOMORECLIPBOARD
HI072533Medicaid