Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | D046607 | MD |
N | 207NS0135X | Procedural Dermatology | D0046607 | MD |
N | 2086S0129X | Vascular Surgeon | D0046607 | MD |
NPI | 1255385498 |
---|---|
Provider Name | Dr. Clement S. K. Banda |
First Address | Columbia, MD 21045-5248 |
Second Address | Columbia, MD 21045-5248 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/05/2006 |
Last Update Date | 16/02/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F67646 | (02) | MD |