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General NPI Number Information
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NPI Number | 1992988455
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Entity Type | Organization
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Legal Business Name | NEW LIFE MEDICAL
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Dates
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Enumeration Date | 12/07/2007
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Last Update Date | 12/07/2007
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Provider Practice Location Address
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Address Line | 8601 MARTIN LUTHER KING JR HWY
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City | LANHAM
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State | MD
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Zip | 20706-1500
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Country | US
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Telephone | 301-773-6812
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Fax |
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Provider Business Mailing Address
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Address Line | 8601 MARTIN LUTHER KING JR HWY
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City | LANHAM
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State | MD
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Zip | 20706-1500
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Country | US
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Telephone | 301-773-6812
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | COLIN CARLTON OTTEY
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Credential | MD
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Telephone | 301-773-6812
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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