Provider Demographics
NPI:1609221886
Name:MARTELLY, MEGHANN LAU (MD)
Entity Type:Individual
Prefix:
First Name:MEGHANN
Middle Name:LAU
Last Name:MARTELLY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MEGHANN
Other - Middle Name:WENWAI
Other - Last Name:LAU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:86-260 FARRINGTON HWY
Mailing Address - Street 2:
Mailing Address - City:WAIANAE
Mailing Address - State:HI
Mailing Address - Zip Code:96792
Mailing Address - Country:US
Mailing Address - Phone:808-697-3300
Mailing Address - Fax:808-697-3930
Practice Address - Street 1:86-260 FARRINGTON HWY
Practice Address - Street 2:
Practice Address - City:WAIANAE
Practice Address - State:HI
Practice Address - Zip Code:96792
Practice Address - Country:US
Practice Address - Phone:808-697-3300
Practice Address - Fax:808-697-3930
Is Sole Proprietor?:No
Enumeration Date:2016-04-26
Last Update Date:2019-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD-20453207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI420745064OtherUS PASSPORT