Provider Demographics
NPI:1518945427
Name:IN, PETER A (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:A
Last Name:IN
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 1:65-1206 MAMALAHOA HWY
Mailing Address - Street 2:#3-108
Mailing Address - City:KAMUELA
Mailing Address - State:HI
Mailing Address - Zip Code:96743-7302
Mailing Address - Country:US
Mailing Address - Phone:808-885-7444
Mailing Address - Fax:808-885-0716
Practice Address - Street 1:65-1206 MAMALAHOA HWY
Practice Address - Street 2:#3-108
Practice Address - City:KAMUELA
Practice Address - State:HI
Practice Address - Zip Code:96743-7302
Practice Address - Country:US
Practice Address - Phone:808-885-7444
Practice Address - Fax:808-885-0716
Is Sole Proprietor?:No
Enumeration Date:2006-01-03
Last Update Date:2014-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD-23192084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI03519901Medicaid
HI03519901Medicaid
HIOOOOBDDLVMedicare ID - Type Unspecified