Provider Demographics
NPI:1699161158
Name:BARTOLOME, DALE (MD)
Entity type:Individual
Prefix:DR
First Name:DALE
Middle Name:
Last Name:BARTOLOME
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 1:1801 SKYLINE DR
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96817-2006
Mailing Address - Country:US
Mailing Address - Phone:808-343-6341
Mailing Address - Fax:
Practice Address - Street 1:46-056 KAMEHAMEHA HWY
Practice Address - Street 2:
Practice Address - City:KANEOHE
Practice Address - State:HI
Practice Address - Zip Code:96744-3755
Practice Address - Country:US
Practice Address - Phone:808-343-6431
Practice Address - Fax:808-443-0297
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-11
Last Update Date:2015-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI17297207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine