Healthcare Provider Details

I. General information

NPI: 1265360630
Provider Name (Legal Business Name): RICHARD DOMINIC NOYNOYAN NOVILLA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2026
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 MEDSTAR BLVD STE 325
BEL AIR MD
21015-1817
US

IV. Provider business mailing address

2174 SEWANEE DR
FOREST HILL MD
21050-1674
US

V. Phone/Fax

Practice location:
  • Phone: 410-803-3187
  • Fax:
Mailing address:
  • Phone: 443-616-9630
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: