Provider Demographics
NPI:1285639971
Name:PAUL, MARY LINDA (MD)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:LINDA
Last Name:PAUL
Suffix:
Gender:F
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:PO BOX 669
Mailing Address - Street 2:ATTEN: RHONELLE ACERET
Mailing Address - City:WAIMEA
Mailing Address - State:HI
Mailing Address - Zip Code:96796-0669
Mailing Address - Country:US
Mailing Address - Phone:808-240-2723
Mailing Address - Fax:808-338-9420
Practice Address - Street 1:4489 PAPALINA ROAD
Practice Address - Street 2:
Practice Address - City:KALAHEO
Practice Address - State:HI
Practice Address - Zip Code:96741
Practice Address - Country:US
Practice Address - Phone:808-332-8523
Practice Address - Fax:808-332-7050
Is Sole Proprietor?:No
Enumeration Date:2005-06-17
Last Update Date:2019-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI990358977170100000X
HIMD-11685207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No170100000XOther Service ProvidersMedical Genetics, Ph.D. Medical Genetics
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI50008403Medicaid
HI54430Medicare ID - Type Unspecified
HI50008403Medicaid