Provider Demographics
NPI:1487742128
Name:TERAMOTO, RAE NAGAO (MD)
Entity type:Individual
Prefix:
First Name:RAE
Middle Name:NAGAO
Last Name:TERAMOTO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:RAE
Other - Middle Name:REIKO
Other - Last Name:NAGAO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:321 N KUAKINI ST
Mailing Address - Street 2:SUITE #201
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96817-2364
Mailing Address - Country:US
Mailing Address - Phone:808-523-8611
Mailing Address - Fax:
Practice Address - Street 1:321 N KUAKINI ST
Practice Address - Street 2:SUITE #201
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-2364
Practice Address - Country:US
Practice Address - Phone:808-523-8611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD-5462207R00000X, 207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Not Answered207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI02195501Medicaid
C97537Medicare UPIN
BDMSHMedicare ID - Type Unspecified