Provider Demographics
NPI:1750421723
Name:TAHA, ALA ELDIN (MD)
Entity type:Individual
Prefix:
First Name:ALA ELDIN
Middle Name:
Last Name:TAHA
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 1:1700 ALA MOANA BLVD APT 3503
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96815-1478
Mailing Address - Country:US
Mailing Address - Phone:609-606-5334
Mailing Address - Fax:
Practice Address - Street 1:45-710 KEAAHA ROAD
Practice Address - Street 2:HAWAII STATE HOSPITAL
Practice Address - City:KANEOHE
Practice Address - State:HI
Practice Address - Zip Code:96744
Practice Address - Country:US
Practice Address - Phone:808-247-2191
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2014-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA0574222084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJTA765700Medicare ID - Type Unspecified
F78211Medicare UPIN