| Prohealth Primary Care Llc | |
|
115 W Bel Air Ave Aberdeen MD 21001-3221 | |
| (410) 272-3377 | |
| (410) 273-1479 |
| Full Name | Prohealth Primary Care Llc |
|---|---|
| Speciality | Pediatrics |
| Location | 115 W Bel Air Ave, Aberdeen, Maryland |
| Authorized Official Name and Position | Nathaniel Sumilang (PHYSICIAN/OWNER) |
| Authorized Official Contact | 4102723377 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Prohealth Primary Care Llc 115 W Bel Air Ave Aberdeen MD 21001-3221 Ph: (410) 272-3377 | Prohealth Primary Care Llc 115 W Bel Air Ave Aberdeen MD 21001-3221 Ph: (410) 272-3377 |
| NPI Number | 1982962692 |
|---|---|
| Provider Enumeration Date | 05/01/2012 |
| Last Update Date | 05/01/2012 |
| Medicare PECOS PAC ID | 7214183227 |
|---|---|
| Medicare Enrollment ID | O20120807000661 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1982962692 | NPI | - | NPPES |
| 402019701 | Medicaid | MD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | M38486 (Maryland) | Secondary |
| 208000000X | Pediatrics | D0059126 (Maryland) | Primary |
| Provider Name | Gwenneth O Cancino |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1487657227 PECOS PAC ID: 3072412188 Enrollment ID: I20101122000020 |
| Provider Name | Nathaniel M Sumilang |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1932192754 PECOS PAC ID: 4486800497 Enrollment ID: I20120807000687 |
| Provider Name | Christopher James Cancino |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1316326846 PECOS PAC ID: 4688024714 Enrollment ID: I20240102001243 |
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