Provider Demographics
NPI:1861216293
Name:NEW ERA CLINIC LLC
Entity type:Organization
Organization Name:NEW ERA CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:OLAPEJU
Authorized Official - Middle Name:
Authorized Official - Last Name:ODU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-404-9354
Mailing Address - Street 1:770 BLUE MOON LN
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:MD
Mailing Address - Zip Code:21157-6878
Mailing Address - Country:US
Mailing Address - Phone:301-404-9354
Mailing Address - Fax:
Practice Address - Street 1:770 BLUE MOON LN
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21157-6878
Practice Address - Country:US
Practice Address - Phone:301-404-9354
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-12
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontologyGroup - Multi-Specialty