Provider Demographics
NPI:1912001942
Name:ROSSI, PETER W (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:W
Last Name:ROSSI
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 1:600 KAPIOLANI BLVD
Mailing Address - Street 2:SUITE 404
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-5147
Mailing Address - Country:US
Mailing Address - Phone:808-550-2415
Mailing Address - Fax:
Practice Address - Street 1:600 KAPIOLANI BLVD
Practice Address - Street 2:SUITE 404
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-5147
Practice Address - Country:US
Practice Address - Phone:808-550-2415
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-11
Last Update Date:2009-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI117182084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIBD941ZMedicare PIN
HIE19445Medicare UPIN