Provider Demographics
NPI:1255385498
Name:BANDA, CLEMENT S K (MD)
Entity type:Individual
Prefix:DR
First Name:CLEMENT
Middle Name:S K
Last Name:BANDA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:7120 MINSTREL WAY
Mailing Address - Street 2:SUITE 103
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045-5248
Mailing Address - Country:US
Mailing Address - Phone:443-283-0600
Mailing Address - Fax:443-283-0399
Practice Address - Street 1:7120 MINSTREL WAY
Practice Address - Street 2:SUITE 103
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-5248
Practice Address - Country:US
Practice Address - Phone:443-283-0600
Practice Address - Fax:443-283-0399
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2019-02-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDD0046607202K00000X, 207NS0135X, 2086S0129X
MDD046607207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No202K00000XAllopathic & Osteopathic PhysiciansPhlebology
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDF67646Medicare UPIN