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General NPI Number Information
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NPI Number | 1750693503
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Entity Type | Organization
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Legal Business Name | MD LASER MEDICINE AND SURGERY INC
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Dates
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Enumeration Date | 07/09/2010
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Last Update Date | 02/16/2019
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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 | 443-283-0600
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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 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 | 443-283-0600
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Fax | 443-283-0399
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. CLEMENT S BANDA
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Credential | M.D.
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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 | 202K00000X
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Taxonomy Name | Phlebology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207NS0135X
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Taxonomy Name | Procedural Dermatology Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number |
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License Number State |
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