Provider Demographics
NPI:1679654024
Name:WORCHEL, BARRY JASON (MD)
Entity Type:Individual
Prefix:DR
First Name:BARRY
Middle Name:JASON
Last Name:WORCHEL
Suffix:
Gender:M
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:PO BOX 1373
Mailing Address - Street 2:
Mailing Address - City:HONOKAA
Mailing Address - State:HI
Mailing Address - Zip Code:96727-1373
Mailing Address - Country:US
Mailing Address - Phone:808-345-0169
Mailing Address - Fax:
Practice Address - Street 1:37 KEKAULIKE ST
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-2462
Practice Address - Country:US
Practice Address - Phone:808-933-0409
Practice Address - Fax:808-933-0595
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI118892084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI0000246249OtherHMSA
HI0000549230Medicaid
HI0000549230Medicaid
HI0000246249OtherHMSA