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NPI Code Detail

MEDICARE: MR. XAVIER ANTONIO BONILLA PHD

MEDICARE: MR. XAVIER ANTONIO BONILLA PHD
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
1103T00000XPsychologist07314MD
2101YM0800XMental Health CounselorLC4176MD

General Provider Information

NPI Number : 1922384999
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. XAVIER ANTONIO BONILLA PHD
Provider Business Mailing Address
First Line : 4 W MAIN ST
Second Line :
City : NEW MARKET
State : MD
Zip : 21774-6290
Country : US
Telephone Number : 301-381-4586
Fax Number : 240-563-0460
Provider Business Practice Location Address
First Line : 4 W MAIN ST
Second Line :
City : NEW MARKET
State : MD
Zip : 21774-6290
Country : US
Telephone Number : 301-381-4586
Fax Number : 240-563-0460
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/22/2011
Last Update Date : 09/04/2025

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