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General NPI Number Information
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NPI Number | 1952274516
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Entity Type | Organization
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Legal Business Name | NOVARA HEALTHCARE LLC
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Dates
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Enumeration Date | 09/29/2025
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Last Update Date | 09/30/2025
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Provider Practice Location Address
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Address Line | 2401 BRANDERMILL BLVD STE 330
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City | GAMBRILLS
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State | MD
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Zip | 21054-1604
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Country | US
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Telephone | 443-401-5544
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Fax |
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Provider Business Mailing Address
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Address Line | 2401 BRANDERMILL BLVD STE 330
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City | GAMBRILLS
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State | MD
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Zip | 21054-1604
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Country | US
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Telephone | 443-401-5544
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Fax |
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Authorized Official
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Title or Position | MD
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Name | GABRIEL AGBANYIM
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Credential | MD
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Telephone | 443-401-5544
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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