Healthcare Provider Details

I. General information

NPI: 1255385498
Provider Name (Legal Business Name): CLEMENT S. K. BANDA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2006
Last Update Date: 02/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7120 MINSTREL WAY SUITE 103
COLUMBIA MD
21045-5248
US

IV. Provider business mailing address

7120 MINSTREL WAY SUITE 103
COLUMBIA MD
21045-5248
US

V. Phone/Fax

Practice location:
  • Phone: 443-283-0600
  • Fax: 443-283-0399
Mailing address:
  • Phone: 443-283-0600
  • Fax: 443-283-0399

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code202K00000X
TaxonomyPhlebology Physician
License NumberD0046607
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License NumberD0046607
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberD0046607
License Number StateMD
# 4
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberD046607
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: