Provider Demographics
NPI:1508216524
Name:PAPACONSTADOPOULOS, IRENE (MD)
Entity Type:Individual
Prefix:DR
First Name:IRENE
Middle Name:
Last Name:PAPACONSTADOPOULOS
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 1:141 HEKUAWA ST
Mailing Address - Street 2:
Mailing Address - City:HAIKU
Mailing Address - State:HI
Mailing Address - Zip Code:96708-7009
Mailing Address - Country:US
Mailing Address - Phone:732-923-7250
Mailing Address - Fax:732-923-7255
Practice Address - Street 1:141 HEKUAWA ST
Practice Address - Street 2:
Practice Address - City:HAIKU
Practice Address - State:HI
Practice Address - Zip Code:96708-7009
Practice Address - Country:US
Practice Address - Phone:732-923-7250
Practice Address - Fax:732-923-7255
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-21
Last Update Date:2020-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
HIMD-19889208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI827892Medicaid