Healthcare Provider Details

I. General information

NPI: 1487300752
Provider Name (Legal Business Name): PROSPERITY MEDICAL AND HEALTH SYSTEM, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/25/2022
Last Update Date: 03/10/2022
Certification Date: 03/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13922 BALTIMORE AVE
LAUREL MD
20707-5009
US

IV. Provider business mailing address

13922 BALTIMORE AVE
LAUREL MD
20707-5009
US

V. Phone/Fax

Practice location:
  • Phone: 301-483-3333
  • Fax: 301-483-3336
Mailing address:
  • Phone: 301-483-3333
  • Fax: 301-483-3336

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MATHIAS C BAMA
Title or Position: OWNER
Credential: MD
Phone: 301-483-3333