Nugahealth Primary Care Llc | |
11636 Port Royal Ave Waldorf MD 20602-5193 | |
(240) 755-1452 | |
Not Available |
Full Name | Nugahealth Primary Care Llc |
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Speciality | Clinic/Center |
Location | 11636 Port Royal Ave, Waldorf, Maryland |
Authorized Official Name and Position | Omobolanle M Adenuga (NURSE PRACTITIONER) |
Authorized Official Contact | 2407551452 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Nugahealth Primary Care Llc 11636 Port Royal Ave Waldorf MD 20602-5193 Ph: () - | Nugahealth Primary Care Llc 11636 Port Royal Ave Waldorf MD 20602-5193 Ph: (240) 755-1452 |
NPI Number | 1053959411 |
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Provider Enumeration Date | 12/17/2019 |
Last Update Date | 12/17/2019 |
Medicare PECOS PAC ID | 5991134629 |
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Medicare Enrollment ID | O20200401001820 |
Identifier | Type | State | Issuer |
---|---|---|---|
1053959411 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261Q00000X | Clinic/center | (* (Not Available)) | Primary |
Provider Name | Omobolanle M Adenuga |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1336796465 PECOS PAC ID: 6800225533 Enrollment ID: I20200401001874 |
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