Healthcare Provider Details

I. General information

NPI: 1619100773
Provider Name (Legal Business Name): NIDHI BANSAL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NIDHI MAHESHWARI MD

II. Dates (important events)

Enumeration Date: 08/24/2009
Last Update Date: 11/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6701 FANNIN ST STE 1020
HOUSTON TX
77030-2611
US

IV. Provider business mailing address

6701 FANNIN ST STE 1020
HOUSTON TX
77030-2611
US

V. Phone/Fax

Practice location:
  • Phone: 832-822-3670
  • Fax:
Mailing address:
  • Phone: 832-822-3670
  • Fax: 832-825-1049

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberP4360
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License NumberP4360
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: