NPIMap

Organization Active NPI

MD Laser Medicine and Surgery Inc

Doing business as MD Vein & Skin Specialists

  • Dermatology Physician
  • Columbia, MD
National Provider Identifier
1750693503
Registry record updated Feb 16, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
Legal business name
MD LASER MEDICINE AND SURGERY INC
Doing business as
MD Vein & Skin Specialists
Practice address
7120 Minstrel Way
Suite 103
Columbia, MD 21045-5248
Phone
(443) 283-0600
Fax
(443) 283-0399
NPI assigned
Jul 9, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 16, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Clement S Banda, M.D.NPI 1255385498
Title
Medical Director
Phone
(443) 283-0600

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Phlebology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 202K00000X
Dermatology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207N00000X Primary
Procedural Dermatology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207NS0135X

Addresses

Primary practice location

7120 Minstrel Way
Suite 103
Columbia, MD 21045-5248

Mailing address

7120 Minstrel Way
Suite 103
Columbia, MD 21045-5248
Phone (443) 283-0600

Other names 1

  • MD Vein & Skin Specialists Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110502000207 MD Part B Supplier - Clinic/Group Practice 7517142888 Receives reassigned benefits from 1 practitioner
Practice locations: Columbia, MD

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1278633600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1550275200000",
    "number": "1750693503",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7120 MINSTREL WAY",
            "address_2": "SUITE 103",
            "city": "COLUMBIA",
            "state": "MD",
            "postal_code": "210455248",
            "telephone_number": "443-283-0600",
            "fax_number": "443-283-0399"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7120 MINSTREL WAY",
            "address_2": "SUITE 103",
            "city": "COLUMBIA",
            "state": "MD",
            "postal_code": "210455248",
            "telephone_number": "443-283-0600",
            "fax_number": "443-283-0399"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MD LASER MEDICINE AND SURGERY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-07-09",
        "last_updated": "2019-02-16",
        "status": "A",
        "authorized_official_last_name": "BANDA",
        "authorized_official_first_name": "CLEMENT",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "443-283-0600",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "202K00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Phlebology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207NS0135X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology, Procedural Dermatology",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MD Vein & Skin Specialists",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "MD Vein & Skin Specialists",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Columbia, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 16, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.