Provider Demographics
NPI:1376501171
Name:IRELAND, JAMES HENRY-EDWARD (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:HENRY-EDWARD
Last Name:IRELAND
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 1:91-2139 FORT WEAVER RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:EWA BEACH
Mailing Address - State:HI
Mailing Address - Zip Code:96706-3607
Mailing Address - Country:US
Mailing Address - Phone:808-676-4224
Mailing Address - Fax:808-676-4220
Practice Address - Street 1:91-2139 FORT WEAVER RD
Practice Address - Street 2:SUITE 100
Practice Address - City:EWA BEACH
Practice Address - State:HI
Practice Address - Zip Code:96706-3607
Practice Address - Country:US
Practice Address - Phone:808-676-4224
Practice Address - Fax:808-676-4220
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2013-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI11863207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
000025353-4OtherHMSA
HI570300-03Medicaid
HI570300-04Medicaid
HI570300-01Medicaid
HI570300-02Medicaid
100711Medicare ID - Type Unspecified
HI570300-01Medicaid