Provider Demographics
NPI:1013069517
Name:BUSH, TEREZIA A (MD)
Entity type:Individual
Prefix:DR
First Name:TEREZIA
Middle Name:A
Last Name:BUSH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 MAHALANI ST
Mailing Address - Street 2:
Mailing Address - City:WAILUKU
Mailing Address - State:HI
Mailing Address - Zip Code:96793-2526
Mailing Address - Country:US
Mailing Address - Phone:808-244-9056
Mailing Address - Fax:
Practice Address - Street 1:221 MAHALANI ST
Practice Address - Street 2:
Practice Address - City:WAILUKU
Practice Address - State:HI
Practice Address - Zip Code:96793-2526
Practice Address - Country:US
Practice Address - Phone:808-244-9056
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI14232208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI00002701957OtherHMSA BILLING NUMNBER
MD62543602OtherCAREFIRST OF MARYLAND
MD5630534OtherAETNA NON-HMO
HI613663-02Medicaid
DCC0410032OtherCAREFIRST OF DC
MD2120395OtherMAMSI HMO
MDP00154992OtherRAILROAD MEDICARE
MD3441675OtherAETNA HMO
MD403474100Medicaid
MDP00154992OtherRAILROAD MEDICARE
MD2120395OtherMAMSI HMO
HI00002701957OtherHMSA BILLING NUMNBER