Healthcare Provider Details

I. General information

NPI: 1346581105
Provider Name (Legal Business Name): MD LASER SURGERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2013
Last Update Date: 09/19/2025
Certification Date: 09/19/2025
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 STE 103
COLUMBIA MD
21045-5274
US

V. Phone/Fax

Practice location:
  • Phone: 410-312-5248
  • Fax: 443-283-0399
Mailing address:
  • Phone: 410-312-5248
  • Fax: 443-283-0399

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License NumberA1546
License Number StateMD

VIII. Authorized Official

Name: DR. CLEMENT S. K. BANDA
Title or Position: OWNER
Credential: MD
Phone: 443-283-0600