Provider Demographics
NPI:1063402469
Name:JANCATERINO, JON S (MD)
Entity type:Individual
Prefix:DR
First Name:JON
Middle Name:S
Last Name:JANCATERINO
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 1:421 OLOHANA ST
Mailing Address - Street 2:#2903
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96815
Mailing Address - Country:US
Mailing Address - Phone:508-741-7626
Mailing Address - Fax:
Practice Address - Street 1:MAUI MEMORIAL MEDICAL CENTER
Practice Address - Street 2:221 MAHALANI ST
Practice Address - City:WAILUKU
Practice Address - State:HI
Practice Address - Zip Code:96793
Practice Address - Country:US
Practice Address - Phone:808-242-2290
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI7648207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3086674Medicaid
MA3086674Medicaid
F14046Medicare UPIN