Provider Demographics
NPI:1265450118
Name:CONSELMAN, NICOLE S (MD)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:S
Last Name:CONSELMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1975 ALPHA DR
Mailing Address - Street 2:SUITE 204
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75087-4951
Mailing Address - Country:US
Mailing Address - Phone:469-800-2100
Mailing Address - Fax:469-800-3310
Practice Address - Street 1:1975 ALPHA DR
Practice Address - Street 2:SUITE 204
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75087-4951
Practice Address - Country:US
Practice Address - Phone:469-800-2100
Practice Address - Fax:469-800-3310
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL2196207R00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX163006301Medicaid
TX405265YT5NMedicare PIN
TX163006301Medicaid
TXH51465Medicare UPIN
TX8666N7Medicare PIN