Provider Demographics
NPI:1225563117
Name:CONA HEALTH CLINIC, LLC
Entity Type:Organization
Organization Name:CONA HEALTH CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CHINWENDU
Authorized Official - Middle Name:N
Authorized Official - Last Name:EZEORU
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:301-605-5916
Mailing Address - Street 1:9887 GOOD LUCK RD
Mailing Address - Street 2:# 7
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-3219
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9887 GOOD LUCK RD
Practice Address - Street 2:# 7
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-3219
Practice Address - Country:US
Practice Address - Phone:301-605-5916
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-27
Last Update Date:2017-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR201815261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care