Provider Demographics
NPI:1952314536
Name:NAGASHIMA, TADAO (MD)
Entity Type:Individual
Prefix:DR
First Name:TADAO
Middle Name:
Last Name:NAGASHIMA
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 1:1385 KENEKI PL
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-3469
Mailing Address - Country:US
Mailing Address - Phone:808-959-1140
Mailing Address - Fax:808-959-1140
Practice Address - Street 1:1441 KAPIOLANI BLVD #2000
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814
Practice Address - Country:US
Practice Address - Phone:808-945-3719
Practice Address - Fax:808-945-3629
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2024-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1822208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI030711-01Medicaid
34165OtherHMSA
100521Medicare ID - Type Unspecified
HI030711-01Medicaid