Provider Demographics
NPI:1639110976
Name:TANABE, MARIANNE (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIANNE
Middle Name:
Last Name:TANABE
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 1:677 ALA MOANA BLVD
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-5471
Mailing Address - Country:US
Mailing Address - Phone:808-535-5975
Mailing Address - Fax:808-535-5976
Practice Address - Street 1:347 NORTH KUAKINI STREET, HPM-9
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817
Practice Address - Country:US
Practice Address - Phone:808-523-8461
Practice Address - Fax:808-528-1897
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD6117174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI029809-09Medicaid
HI029809-04Medicaid
HIF72014Medicare UPIN
HI56299Medicare ID - Type Unspecified