MEDICARE: NOELLA MASALLA

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	R208446	MD
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	0024193733	VA
3	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	NP1031963	DC

General Provider Information

NPI Number	:	1306107867
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NOELLA MASALLA

Provider Business Mailing Address
First Line	:	11201 HOMESTEAD DR APT A2
Second Line	:
City	:	UPPER MARLBORO
State	:	MD
Zip	:	20774-5761
Country	:	US
Telephone Number	:	240-898-8033
Fax Number	:

Provider Business Practice Location Address
First Line	:	9811 MALLARD DR STE 210
Second Line	:
City	:	LAUREL
State	:	MD
Zip	:	20708-3199
Country	:	US
Telephone Number	:	443-713-8643
Fax Number	:

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

Provider Enumeration Date	:	05/31/2012
Last Update Date	:	03/16/2026

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Directions to “ NOELLA MASALLA ” Practice Location

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