Provider Demographics
NPI:1518054824
Name:NEAL, RANDOLPH DALE (MD)
Entity Type:Individual
Prefix:DR
First Name:RANDOLPH
Middle Name:DALE
Last Name:NEAL
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:PO BOX 10804
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96816-0804
Mailing Address - Country:US
Mailing Address - Phone:808-295-4340
Mailing Address - Fax:808-373-8846
Practice Address - Street 1:1601 PUNAHOU ST
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96822-3336
Practice Address - Country:US
Practice Address - Phone:808-295-4340
Practice Address - Fax:808-373-8846
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2013-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD38392084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI04249201Medicaid
HID36397Medicare UPIN
HI04249201Medicaid