Provider Demographics
NPI:1992988455
Name:NEW LIFE MEDICAL
Entity type:Organization
Organization Name:NEW LIFE MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:COLIN
Authorized Official - Middle Name:CARLTON
Authorized Official - Last Name:OTTEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-773-6812
Mailing Address - Street 1:8601 MARTIN LUTHER KING JR HWY
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-1500
Mailing Address - Country:US
Mailing Address - Phone:301-773-6812
Mailing Address - Fax:
Practice Address - Street 1:8601 MARTIN LUTHER KING JR HWY
Practice Address - Street 2:
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-1500
Practice Address - Country:US
Practice Address - Phone:301-773-6812
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COLIN OTTEY MD, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-12-07
Last Update Date:2007-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care