Provider Demographics
NPI:1023119385
Name:NITTA, FREDERICK ALAN (MD)
Entity type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:ALAN
Last Name:NITTA
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 1:670 PONAHAWAI ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-2660
Mailing Address - Country:US
Mailing Address - Phone:808-961-5922
Mailing Address - Fax:808-969-1924
Practice Address - Street 1:670 PONAHAWAI ST
Practice Address - Street 2:SUITE 200
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-2660
Practice Address - Country:US
Practice Address - Phone:808-961-5922
Practice Address - Fax:808-969-1924
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2008-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD6338207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI041524-01Medicaid
HI04569-0OtherHMSA QUEST
HI04569-0OtherHMSA
HIH54352Medicare ID - Type UnspecifiedMEDICARE
HIF59863Medicare UPIN