Provider Demographics
NPI:1265771828
Name:DONALD E NICOL MD INC
Entity type:Organization
Organization Name:DONALD E NICOL MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:NICOL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-373-2164
Mailing Address - Street 1:549 HALEMAUMAU ST STE F
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96821-2150
Mailing Address - Country:US
Mailing Address - Phone:808-373-2164
Mailing Address - Fax:808-377-9705
Practice Address - Street 1:549 HALEMAUMAU ST STE F
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96821-2150
Practice Address - Country:US
Practice Address - Phone:808-373-2164
Practice Address - Fax:808-377-9705
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-01
Last Update Date:2015-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI3657305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI00C0046874OtherHMSA MEDICAID
HI1053367284OtherHMSA
HI1053367284OtherHMA, INC
HI1053367284OtherAETNA
HI1053367284OtherHMAA
HI04242601Medicaid
HI1053367284OtherHUMANA
HI04242601OtherAOHACARE
HI1053367284OtherMDX HI
HI1053367284OtherUNITED HEALTHCARE
HI04242601Medicaid
HID36401Medicare UPIN