Provider Demographics
NPI:1629008438
Name:NEW ERA VISITING PHYSICIAN LLC
Entity Type:Organization
Organization Name:NEW ERA VISITING PHYSICIAN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ELIAS
Authorized Official - Middle Name:G
Authorized Official - Last Name:DEMOZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:804-264-0494
Mailing Address - Street 1:8736 LANDMARK RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23228-2802
Mailing Address - Country:US
Mailing Address - Phone:804-264-0494
Mailing Address - Fax:804-264-0495
Practice Address - Street 1:8736 LANDMARK RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23228-2802
Practice Address - Country:US
Practice Address - Phone:804-264-0494
Practice Address - Fax:804-264-0495
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101235406207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC09666Medicare PIN