Provider Demographics
NPI:1336195627
Name:PISHCHALENKO, OLEKSANDR (MD)
Entity type:Individual
Prefix:DR
First Name:OLEKSANDR
Middle Name:
Last Name:PISHCHALENKO
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 1:677 ALA MOANA BLVD,
Mailing Address - Street 2:SUITE 1025
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-5419
Mailing Address - Country:US
Mailing Address - Phone:808-535-5975
Mailing Address - Fax:808-535-5976
Practice Address - Street 1:347 N. KUAKINI ST, HPM-9
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817
Practice Address - Country:US
Practice Address - Phone:808-523-8461
Practice Address - Fax:808-528-1897
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD11104174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI507189-03Medicaid
HI507189-04Medicaid
HI100678Medicare ID - Type Unspecified