Provider Demographics
NPI:1992759211
Name:CARCAMO, ALEX SAMUEL (MD)
Entity type:Individual
Prefix:
First Name:ALEX
Middle Name:SAMUEL
Last Name:CARCAMO
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 1:100 KAHELU AVE STE 226
Mailing Address - Street 2:
Mailing Address - City:MILILANI
Mailing Address - State:HI
Mailing Address - Zip Code:96789-3962
Mailing Address - Country:US
Mailing Address - Phone:808-772-2837
Mailing Address - Fax:818-583-1730
Practice Address - Street 1:100 KAHELU AVE STE 226
Practice Address - Street 2:
Practice Address - City:MILILANI
Practice Address - State:HI
Practice Address - Zip Code:96789-3962
Practice Address - Country:US
Practice Address - Phone:808-621-1000
Practice Address - Fax:808-627-6000
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2016-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA87398207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAI46561Medicare UPIN