Basic Information
Provider Information
NPI: 1851415046
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ELSEMARY
FirstName: DALIA
MiddleName: MOHAMED
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 801 S KING ST APT 2504
Address2:  
City: HONOLULU
State: HI
PostalCode: 968133031
CountryCode: US
TelephoneNumber: 4128182519
FaxNumber:  
Practice Location
Address1: 347 N KUAKINI ST
Address2: HPM9
City: HONOLULU
State: HI
PostalCode: 968172336
CountryCode: US
TelephoneNumber: 8085238461
FaxNumber:  
Other Information
ProviderEnumerationDate: 03/16/2007
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RG0300X13097HIY Allopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine

No ID Information.


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