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PROHEALTH PRIMARY CARE LLC NPI 1982962692


NPI Information

NPI: 1982962692
Provider Name: PROHEALTH PRIMARY CARE LLC
Classification: Pediatrics - 208000000X
Entity Type: Organization

CLIA Number: 21D1011199

Address:
115 W BEL AIR AVE
ABERDEEN, MD
ZIP 21001
Phone: (410) 272-3377
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PROHEALTH PRIMARY CARE LLC is a pediatrics in Aberdeen, MD. The provider is a pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development. PROHEALTH PRIMARY CARE LLC NPI is 1982962692. The provider is registered as an organization entity type and is a multiple single specialty group.

The provider's business location address is:

115 W BEL AIR AVE
ABERDEEN, MD
ZIP 21001-221
Phone: (410) 272-3377
Fax: (410) 273-1479

The provider's authorized official is Nathaniel Sumilang .
The authorized official title is Physician/owner and has the following contact phone number (410) 272-3377.

The CLIA number assigned to this NPI record is 21D1011199 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 5/1/2012 and was last updated on 5/1/2012.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1207Q00000XFamily MedicineM38486MARYLANDNo
2208000000XPediatricsD0059126MARYLANDYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1402019701MEDICAIDMARYLAND

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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