MEDICARE: NATHANIEL MARFAL SUMILANG M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	M53916	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	67191000000	OTHER	MD	PREFERRED HEALTH
2	9301757002	OTHER	MD	CIGNA
3	187729	OTHER	MD	AMERIGROUP
4	30-0157915	OTHER	MD	ALL OTHERS
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	KEX5PR	OTHER	MD	BLUE CROSS
8	2110064	OTHER	MD	MAMSI/ OPTIMUM CHOICE
9	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
10	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
11	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
12	6251	OTHER	MD	FREE STATE/ MID ATLANTIC

General Provider Information

NPI Number	:	1932192754
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NATHANIEL MARFAL SUMILANG M.D.

Provider Business Mailing Address
First Line	:	115 W BEL AIR AVE
Second Line	:
City	:	ABERDEEN
State	:	MD
Zip	:	21001-3221
Country	:	US
Telephone Number	:	410-272-3377
Fax Number	:	410-273-1479

Provider Business Practice Location Address
First Line	:	115 W BEL AIR AVE
Second Line	:
City	:	ABERDEEN
State	:	MD
Zip	:	21001-3221
Country	:	US
Telephone Number	:	410-272-3007
Fax Number	:	410-273-1479

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/26/2005
Last Update Date	:	10/01/2012

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