Provider Demographics
NPI:1548343536
Name:GADAM, SAMUEL V (MD)
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:V
Last Name:GADAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1010 PENSACOLA ST
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-2118
Mailing Address - Country:US
Mailing Address - Phone:808-432-2000
Mailing Address - Fax:
Practice Address - Street 1:1 JARRETT WHITE RD
Practice Address - Street 2:
Practice Address - City:TRIPLER ARMY MEDICAL CENTER
Practice Address - State:HI
Practice Address - Zip Code:96859-5001
Practice Address - Country:US
Practice Address - Phone:808-433-6060
Practice Address - Fax:808-433-3339
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
HI118872084P0800X
HIMD-118872084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI0000237487OtherHMSA BILLING NUMBER
HI519027-01Medicaid
HI0000237487OtherHMSA BILLING NUMBER
HIH54969Medicare PIN