Individual
CHARLES THOMAS MAURO IV
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
868 ULULANI ST, SUITE 103, HILO, HI 96720-3913
(808) 961-3427
Mailing address
868 ULULANI ST, SUITE 103, HILO, HI 96720-3913
(808) 961-3427
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
MD12734
HI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12D1029385
CLIA NUMBER
HI
Enumeration date
07/27/2006
Last updated
07/09/2007
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