Provider Demographics
NPI:1558534743
Name:BERTHIAUME, JOHN THOMAS (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:THOMAS
Last Name:BERTHIAUME
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 1:818 KEEAUMOKU ST
Mailing Address - Street 2:SUITE 517
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-2393
Mailing Address - Country:US
Mailing Address - Phone:808-948-5287
Mailing Address - Fax:808-948-6887
Practice Address - Street 1:818 KEEAUMOKU ST
Practice Address - Street 2:SUITE 517
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-2393
Practice Address - Country:US
Practice Address - Phone:808-948-5287
Practice Address - Fax:808-948-6887
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-08
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI3680207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine