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General NPI Number Information
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NPI Number | 1346581105
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Entity Type | Organization
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Legal Business Name | MD LASER SURGERY CENTER, LLC
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Dates
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Enumeration Date | 03/04/2013
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Last Update Date | 09/19/2025
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Provider Practice Location Address
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Address Line | 7120 MINSTREL WAY SUITE 103
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City | COLUMBIA
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State | MD
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Zip | 21045-5248
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Country | US
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Telephone | 410-312-5248
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Fax | 443-283-0399
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Provider Business Mailing Address
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Address Line | 7120 MINSTREL WAY STE 103
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City | COLUMBIA
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State | MD
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Zip | 21045-5274
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Country | US
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Telephone | 410-312-5248
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Fax | 443-283-0399
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Authorized Official
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Title or Position | OWNER
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Name | DR. CLEMENT S. K. BANDA
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Credential | MD
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Telephone | 443-283-0600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | A1546
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License Number State | MD
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