Provider Demographics
NPI:1922060391
Name:NICOLWALA, ADIL NOSHIR (MD)
Entity Type:Individual
Prefix:DR
First Name:ADIL
Middle Name:NOSHIR
Last Name:NICOLWALA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1500 UNIVERSITY DR E
Mailing Address - Street 2:SUITE 100
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77840-2600
Mailing Address - Country:US
Mailing Address - Phone:979-846-1100
Mailing Address - Fax:979-260-9390
Practice Address - Street 1:1651 ROCK PRAIRIE RD
Practice Address - Street 2:SUITE 102
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77845-8652
Practice Address - Country:US
Practice Address - Phone:979-693-7400
Practice Address - Fax:979-693-7446
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2013-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXL0879207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1544678-01OtherBCSCHC FQHC SITE MEDICAID NUMBER
TX80565YOtherBLUE CROSS
TX1649265646OtherFQHC SITE NPI/BCSCHC
TX1821185299OtherAGENCY NPI
TX43972102Medicaid
TX80565YOtherBLUE CROSS
TX1649265646OtherFQHC SITE NPI/BCSCHC
TX8565J5Medicare PIN