Provider Demographics
NPI:1629131933
Name:BANSAL, NIDHI (MD)
Entity Type:Individual
Prefix:DR
First Name:NIDHI
Middle Name:
Last Name:BANSAL
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 1:930 20TH ST S
Mailing Address - Street 2:SUITE 325
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35205-2610
Mailing Address - Country:US
Mailing Address - Phone:205-934-9700
Mailing Address - Fax:205-975-6962
Practice Address - Street 1:930 20TH ST S
Practice Address - Street 2:SUITE 325
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35205-2610
Practice Address - Country:US
Practice Address - Phone:205-934-9700
Practice Address - Fax:205-975-6962
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL18813207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL01-13000OtherUNITEDHEALTHCARE
AL51514608OtherBLUE CROSS & BLUE SHIELD
AL01-13000OtherUNITEDHEALTHCARE