Provider Demographics
NPI:1790032340
Name:STUART LERNER, M.D. LLC
Entity Type:Organization
Organization Name:STUART LERNER, M.D. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARYANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCLOSKEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-954-4463
Mailing Address - Street 1:970 N KALAHEO AVE STE C316
Mailing Address - Street 2:
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-1883
Mailing Address - Country:US
Mailing Address - Phone:180-895-4446
Mailing Address - Fax:
Practice Address - Street 1:970 N KALAHEO AVE STE C316
Practice Address - Street 2:
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-1883
Practice Address - Country:US
Practice Address - Phone:180-895-4446
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-13
Last Update Date:2021-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD-6750207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI05844207Medicaid
HIGL259AMedicare PIN