Provider Demographics
NPI:1740386325
Name:GLAMB, ROMAN W (MD)
Entity Type:Individual
Prefix:DR
First Name:ROMAN
Middle Name:W
Last Name:GLAMB
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:888 S KING ST
Mailing Address - Street 2:STRAUB DEPARTMENT OF DERMATOLOGY
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-3097
Mailing Address - Country:US
Mailing Address - Phone:808-522-4000
Mailing Address - Fax:808-522-3361
Practice Address - Street 1:888 S KING ST
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-3009
Practice Address - Country:US
Practice Address - Phone:808-522-4000
Practice Address - Fax:808-522-3361
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2012-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD-3592207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI04229401Medicaid
HI00X0046727OtherHMSA
HI6371444OtherUHA
HIC98445Medicare UPIN
HI53776Medicare ID - Type Unspecified