Provider Demographics
NPI:1982670154
Name:KELLY, MELANIE KTH (MD)
Entity Type:Individual
Prefix:DR
First Name:MELANIE
Middle Name:KTH
Last Name:KELLY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MELANIE
Other - Middle Name:KT
Other - Last Name:HO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2230 LILIHA ST
Mailing Address - Street 2:EMERGENCY DEPARTMENT
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96817-1646
Mailing Address - Country:US
Mailing Address - Phone:808-547-6387
Mailing Address - Fax:808-536-5340
Practice Address - Street 1:2230 LILIHA ST
Practice Address - Street 2:EMERGENCY DEPARTMENT
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-1646
Practice Address - Country:US
Practice Address - Phone:808-547-6387
Practice Address - Fax:808-536-5340
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI5891207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI02441903Medicaid
HI02441913Medicaid
HIA008OtherTRICARE
HI02441914Medicaid
HIH103595Medicare PIN
HIA008OtherTRICARE
HI02441903Medicaid