Provider Demographics
NPI:1053367284
Name:NICOL, DONALD EDWARD (MD)
Entity type:Individual
Prefix:DR
First Name:DONALD
Middle Name:EDWARD
Last Name:NICOL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:549 HALEMAUMAU ST
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
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
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-26
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI174400000X174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI1053367284OtherTRI-CARE
HI1053367284OtherAETNA
HI04242601OtherALOHACARE
HI04242601Medicaid
HIH0000BDGNMOtherMEDICARE
HI0000046870OtherHMSA
HI0000046870OtherHMSA
HIH0000BDGNMOtherMEDICARE