Provider Demographics
NPI:1104919620
Name:MCEWAN, DAVID (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:MCEWAN
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 1:1100 WARD AVE
Mailing Address - Street 2:700
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-1600
Mailing Address - Country:US
Mailing Address - Phone:808-544-2625
Mailing Address - Fax:
Practice Address - Street 1:1100 WARD AVE
Practice Address - Street 2:700
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-1600
Practice Address - Country:US
Practice Address - Phone:808-544-2625
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2011-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD-3179207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI44650OtherHMN
HI00X004197-5OtherHMSA
HI787941OtherUHA
HIMD3179OtherMDX
HI038235-01Medicaid
HI709607OtherFIRST HEALTH
HIH0000BDFKJMedicare PIN
HI00X004197-5OtherHMSA