Healthcare Provider Details

I. General information

NPI: 1922060391
Provider Name (Legal Business Name): ADIL NOSHIR NICOLWALA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2006
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3370 S TEXAS AVE
BRYAN TX
77802-3127
US

IV. Provider business mailing address

1500 UNIVERSITY DR E SUITE 100
COLLEGE STATION TX
77840-2600
US

V. Phone/Fax

Practice location:
  • Phone: 979-595-1700
  • Fax:
Mailing address:
  • Phone: 979-846-1100
  • Fax: 979-260-9390

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberL0879
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: