Provider Demographics
NPI:1568627909
Name:MAGDY METTIAS MD INC
Entity Type:Organization
Organization Name:MAGDY METTIAS MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MAGDY
Authorized Official - Middle Name:A
Authorized Official - Last Name:METTIAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-671-1988
Mailing Address - Street 1:94-300 FARRINGTON HWY # E6
Mailing Address - Street 2:
Mailing Address - City:WAIPAHU
Mailing Address - State:HI
Mailing Address - Zip Code:96797-2699
Mailing Address - Country:US
Mailing Address - Phone:808-671-1988
Mailing Address - Fax:808-677-0555
Practice Address - Street 1:94-300 FARRINGTON HWY # E6
Practice Address - Street 2:
Practice Address - City:WAIPAHU
Practice Address - State:HI
Practice Address - Zip Code:96797-2699
Practice Address - Country:US
Practice Address - Phone:808-671-1988
Practice Address - Fax:808-677-0555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-24
Last Update Date:2014-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI7466305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI03508905Medicaid
HIF17643Medicare UPIN