| Mark D Breithaupt Phd Inc | |
|
2200 Main St Wailuku HI 96793-1681 | |
| (808) 205-8403 | |
| Not Available |
| Full Name | Mark D Breithaupt Phd Inc |
|---|---|
| Speciality | Psychologist |
| Location | 2200 Main St, Wailuku, Hawaii |
| Authorized Official Name and Position | Mark Douglas Breithaupt (LICENSED CLINICAL PSYCHOLOGIST) |
| Authorized Official Contact | 8082058403 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mark D Breithaupt Phd Inc Po Box 2632 Wailuku HI 96793-7632 Ph: (808) 205-8403 | Mark D Breithaupt Phd Inc 2200 Main St Wailuku HI 96793-1681 Ph: (808) 205-8403 |
| NPI Number | 1902115082 |
|---|---|
| Provider Enumeration Date | 10/06/2010 |
| Last Update Date | 05/19/2025 |
| Certification Date | 05/19/2025 |
| Medicare PECOS PAC ID | 8123208618 |
|---|---|
| Medicare Enrollment ID | O20110216000359 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1902115082 | NPI | - | NPPES |
| 03451701 | Medicaid | HI | |
| HMSA | Other | HI | HMSA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | PSY499 (Hawaii) | Primary |
| Provider Name | Mark D Breithaupt |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1053436337 PECOS PAC ID: 2264455120 Enrollment ID: I20060106000439 |
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