Provider Demographics
NPI:1841402914
Name:FREDERICK A. NITTA, M.D. INC.
Entity Type:Organization
Organization Name:FREDERICK A. NITTA, M.D. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:NITTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-961-5922
Mailing Address - Street 1:670 PONAHAWAI ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-2660
Mailing Address - Country:US
Mailing Address - Phone:808-961-5922
Mailing Address - Fax:808-969-1924
Practice Address - Street 1:670 PONAHAWAI ST
Practice Address - Street 2:SUITE 200
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-2660
Practice Address - Country:US
Practice Address - Phone:808-961-5922
Practice Address - Fax:808-969-1924
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2010-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VH0002XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyHospice and Palliative MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI54352Medicare ID - Type Unspecified