Healthcare Provider Details

I. General information

NPI: 1093102477
Provider Name (Legal Business Name): NEDAL ADI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2015
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

905 W MEDICAL CENTER BLVD # 402
WEBSTER TX
77598-4009
US

IV. Provider business mailing address

PO BOX 57845
WEBSTER TX
77598-7845
US

V. Phone/Fax

Practice location:
  • Phone: 281-724-1862
  • Fax: 281-724-1859
Mailing address:
  • Phone: 281-724-1862
  • Fax: 281-724-1859

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberR8520
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: