Provider Demographics
NPI:1104880145
Name:SCHWAB, MARK C (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:C
Last Name:SCHWAB
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 1:1887 WILI PA LOOP
Mailing Address - Street 2:SUITE 1
Mailing Address - City:WAILUKU
Mailing Address - State:HI
Mailing Address - Zip Code:96793-1273
Mailing Address - Country:US
Mailing Address - Phone:808-244-8993
Mailing Address - Fax:808-244-9885
Practice Address - Street 1:1887 WILI PA LOOP
Practice Address - Street 2:SUITE 1
Practice Address - City:WAILUKU
Practice Address - State:HI
Practice Address - Zip Code:96793-1273
Practice Address - Country:US
Practice Address - Phone:808-244-8993
Practice Address - Fax:808-244-9885
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
HI6263207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI02675101Medicaid
A92439Medicare UPIN
HIH0000BDPSRMedicare ID - Type Unspecified