Provider Demographics
NPI:1417203126
Name:PEDRI, MARK SILVIO (DO MPH)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:SILVIO
Last Name:PEDRI
Suffix:
Gender:M
Credentials:DO MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1234
Mailing Address - Street 2:
Mailing Address - City:KAUNAKAKAI
Mailing Address - State:HI
Mailing Address - Zip Code:96748-1234
Mailing Address - Country:US
Mailing Address - Phone:808-658-6930
Mailing Address - Fax:808-633-8535
Practice Address - Street 1:130 KAMEHAMEHA V HIGHWAY
Practice Address - Street 2:
Practice Address - City:KAUNAKAKAI
Practice Address - State:HI
Practice Address - Zip Code:96748-1234
Practice Address - Country:US
Practice Address - Phone:808-658-6930
Practice Address - Fax:808-633-8535
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-31
Last Update Date:2017-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDOS-1564208D00000X
WAOP 60428780208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice