Provider Demographics
NPI:1922082049
Name:AEBY, TOD C (MD)
Entity Type:Individual
Prefix:DR
First Name:TOD
Middle Name:C
Last Name:AEBY
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 1:1319 PUNAHOU ST
Mailing Address - Street 2:STE 824
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96826-1001
Mailing Address - Country:US
Mailing Address - Phone:808-203-6519
Mailing Address - Fax:808-955-2174
Practice Address - Street 1:1319 PUNAHOU ST
Practice Address - Street 2:STE 801
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96826-1001
Practice Address - Country:US
Practice Address - Phone:808-949-5305
Practice Address - Fax:808-955-2174
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-01
Last Update Date:2016-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD6114207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI059597Medicaid
E64708Medicare UPIN
HI059597Medicaid