Provider Demographics
NPI:1639339013
Name:TIMOTHY F. MCDEVITT, M.D. INC
Entity Type:Organization
Organization Name:TIMOTHY F. MCDEVITT, M.D. INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:F
Authorized Official - Last Name:MCDEVITT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-599-4755
Mailing Address - Street 1:1380 LUSITANA ST
Mailing Address - Street 2:SUITE 708
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-2449
Mailing Address - Country:US
Mailing Address - Phone:808-599-4755
Mailing Address - Fax:808-599-5397
Practice Address - Street 1:1380 LUSITANA ST
Practice Address - Street 2:SUITE 708
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-2449
Practice Address - Country:US
Practice Address - Phone:808-599-4755
Practice Address - Fax:808-599-5397
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-10
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD7864261QS0132X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0132XAmbulatory Health Care FacilitiesClinic/CenterOphthalmologic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIE94267OtherHMSA
HI07250001Medicaid