Healthcare Provider Details

I. General information

NPI: 1952274516
Provider Name (Legal Business Name): NOVARA HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2025
Last Update Date: 09/30/2025
Certification Date: 09/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 BRANDERMILL BLVD STE 330
GAMBRILLS MD
21054-1604
US

IV. Provider business mailing address

2401 BRANDERMILL BLVD STE 330
GAMBRILLS MD
21054-1604
US

V. Phone/Fax

Practice location:
  • Phone: 443-401-5544
  • Fax:
Mailing address:
  • Phone: 443-401-5544
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: GABRIEL AGBANYIM
Title or Position: MD
Credential: MD
Phone: 443-401-5544