Provider Demographics
NPI:1932192754
Name:SUMILANG, NATHANIEL MARFAL (MD)
Entity Type:Individual
Prefix:
First Name:NATHANIEL
Middle Name:MARFAL
Last Name:SUMILANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 W BEL AIR AVE
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:MD
Mailing Address - Zip Code:21001-3221
Mailing Address - Country:US
Mailing Address - Phone:410-272-3377
Mailing Address - Fax:410-273-1479
Practice Address - Street 1:115 W BEL AIR AVE
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:MD
Practice Address - Zip Code:21001-3221
Practice Address - Country:US
Practice Address - Phone:410-272-3007
Practice Address - Fax:410-273-1479
Is Sole Proprietor?:No
Enumeration Date:2005-08-26
Last Update Date:2012-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDM53916174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD67191000000OtherPREFERRED HEALTH
MD9301757002OtherCIGNA
MD187729OtherAMERIGROUP
MD30-0157915OtherALL OTHERS
DE1000035663Medicaid
MD5316Medicaid
MDKEX5PROtherBLUE CROSS
MD2110064OtherMAMSI/ OPTIMUM CHOICE
MD2282019Medicaid
MD105300Medicaid
MD402019700Medicaid
MD6251OtherFREE STATE/ MID ATLANTIC