Provider Demographics
NPI:1093482705
Name:MEDCITY FAMILY CLINIC LLC
Entity Type:Organization
Organization Name:MEDCITY FAMILY CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FOLASADE
Authorized Official - Middle Name:
Authorized Official - Last Name:ONASANYA
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP
Authorized Official - Phone:443-565-2408
Mailing Address - Street 1:330 W 24TH ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21211-3216
Mailing Address - Country:US
Mailing Address - Phone:443-565-2408
Mailing Address - Fax:
Practice Address - Street 1:330 W 24TH ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21211-3216
Practice Address - Country:US
Practice Address - Phone:443-565-2408
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-30
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty