Provider Demographics
NPI:1770572919
Name:HENRY, THOMAS E (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:E
Last Name:HENRY
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:P.O. BOX 700309
Mailing Address - Street 2:
Mailing Address - City:KAPOLEI
Mailing Address - State:HI
Mailing Address - Zip Code:96709-0309
Mailing Address - Country:US
Mailing Address - Phone:808-203-7943
Mailing Address - Fax:808-693-8060
Practice Address - Street 1:98-084 KAMEHAMEHA HWY
Practice Address - Street 2:SUITE 301B
Practice Address - City:AIEA
Practice Address - State:HI
Practice Address - Zip Code:96701-5160
Practice Address - Country:US
Practice Address - Phone:808-486-4900
Practice Address - Fax:808-486-4901
Is Sole Proprietor?:No
Enumeration Date:2005-10-20
Last Update Date:2016-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD89012084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI211185OtherHMSA
HI02494021OtherALOHACARE
HI00A0211183OtherHMSA
HIMD8901-03OtherMDX HAWAII
HI00A0211183OtherHMSA-QUEST
HI235361OtherUNIVERSITY HEALTH ALLIANC
HI507288-02Medicaid
HI990298651-96706-G003OtherTRICARE
HI235361OtherUNIVERSITY HEALTH ALLIANC
HI507288-02Medicaid