Provider Demographics
NPI:1477715167
Name:MOTIWALA, NISRIN H (MD)
Entity type:Individual
Prefix:DR
First Name:NISRIN
Middle Name:H
Last Name:MOTIWALA
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 1:7941 KATY FWY
Mailing Address - Street 2:#530
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024-1924
Mailing Address - Country:US
Mailing Address - Phone:281-897-8062
Mailing Address - Fax:
Practice Address - Street 1:10655 STEEPLETOP DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77065-4222
Practice Address - Country:US
Practice Address - Phone:281-897-8062
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-25
Last Update Date:2014-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA003075207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2973588-01Medicaid
TX2973588-01Medicaid