Provider Demographics
NPI:1861443319
Name:ANTONELLI, MARY ANN (MD)
Entity Type:Individual
Prefix:DR
First Name:MARY ANN
Middle Name:
Last Name:ANTONELLI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:651 ILALO ST
Mailing Address - Street 2:MEB 3RD FLOOR
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-5525
Mailing Address - Country:US
Mailing Address - Phone:808-692-1000
Mailing Address - Fax:808-692-1251
Practice Address - Street 1:30 AULIKE ST,
Practice Address - Street 2:#301
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734
Practice Address - Country:US
Practice Address - Phone:808-261-8894
Practice Address - Fax:808-261-8894
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
HIMD4592207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI016257-02Medicaid
HI016257-02Medicaid
HIPENDINGMedicare ID - Type Unspecified