Queens.org Provider Directory: Update Your Profile

Allow 3-5 minutes to complete.

To be featured on queens.org and/or to receive referrals through the Queen's Referral Line, a physician must be in good standing with a Queen's hospital or Queen's affiliated medical group with an active, associate, provisional or senior status. If you do not meet these requirements, you do not need to complete this questionnaire.

Start by Telling Us Who You Are

Who is Completing This Questionnaire?

(If you checked "I'm a Doctor", skip this section.)

Provider Info

NPI will be used to validate provider information and will not be shown publicly.

Select any Abbreviated Degree(s) and Certifications that apply.

Queen's Leadership Title (if applicable)

Are you affiliated with any Queen's Physician Network? Check all that apply.

Education & Training

Degree-Granting Education

Professional Credentials

Practice Locations

Primary Practice Location

Practice Location 2

(If Applicable)

Practice Location 3

(If Applicable)

Are You Currently Accepting New Patients?

This information may be updated at any time by calling Queen's Referral Line (808) 691-7117

Queen's Referral Line

Would you like to participate in the Queen's Referral Line Directory?

Language

Select languages available in your office.

Insurance Types Accepted

Select all insurance plans accepted at your office(s).

Notifications

How would you like to be notified about your patients who have been admitted or discharged from The Queen's Medical Center?
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