MEDICARE: DR. ADIL NOSHIR NICOLWALA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	L0879	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1649265646	OTHER	TX	FQHC SITE NPI/BCSCHC
2	1821185299	OTHER	TX	AGENCY NPI
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	80565Y	OTHER	TX	BLUE CROSS

General Provider Information

NPI Number	:	1922060391
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ADIL NOSHIR NICOLWALA MD

Provider Business Mailing Address
First Line	:	1500 UNIVERSITY DR E
Second Line	:	SUITE 100
City	:	COLLEGE STATION
State	:	TX
Zip	:	77840-2600
Country	:	US
Telephone Number	:	979-846-1100
Fax Number	:	979-260-9390

Provider Business Practice Location Address
First Line	:	3370 S TEXAS AVE
Second Line	:
City	:	BRYAN
State	:	TX
Zip	:	77802-3127
Country	:	US
Telephone Number	:	979-595-1700
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/03/2006
Last Update Date	:	06/18/2026

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