Provider Demographics
NPI:1578784708
Name:VASSAR, MARGO (MD)
Entity Type:Individual
Prefix:
First Name:MARGO
Middle Name:
Last Name:VASSAR
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 1:550 S BERETANIA ST STE 601
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-2423
Mailing Address - Country:US
Mailing Address - Phone:808-691-8900
Mailing Address - Fax:808-691-8919
Practice Address - Street 1:550 S BERETANIA ST STE 601
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-2423
Practice Address - Country:US
Practice Address - Phone:808-691-8900
Practice Address - Fax:808-691-8919
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2020-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD-15863207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI648553Medicaid
MD100810200Medicaid