Provider Demographics
NPI:1982962692
Name:PROHEALTH PRIMARY CARE LLC
Entity Type:Organization
Organization Name:PROHEALTH PRIMARY CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NATHANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SUMILANG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-272-3377
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:410-272-3377
Practice Address - Fax:410-273-1479
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-01
Last Update Date:2012-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDM38486207Q00000X
MDD0059126208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD402019701Medicaid