Provider Demographics
NPI:1962544122
Name:WARREN, MARY KATHERINE (MD)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:KATHERINE
Last Name:WARREN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:KATHERINE
Other - Last Name:ROBINSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:75-5995 KUAKINI HWY
Mailing Address - Street 2:SUITE 211
Mailing Address - City:KAILUA KONA
Mailing Address - State:HI
Mailing Address - Zip Code:96740-2144
Mailing Address - Country:US
Mailing Address - Phone:808-329-2500
Mailing Address - Fax:808-334-1808
Practice Address - Street 1:75-5995 KUAKINI HWY
Practice Address - Street 2:SUITE 211
Practice Address - City:KAILUA KONA
Practice Address - State:HI
Practice Address - Zip Code:96740-2144
Practice Address - Country:US
Practice Address - Phone:808-329-2500
Practice Address - Fax:808-334-1808
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI9630207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIA84303OtherHMAA
HI208157OtherHMSA
HI55478951OtherUHA
HI55478951OtherUHA
HIA84303Medicare UPIN