1992888739 NPI number — SUMITA P ASTHANA MD

Table of content: SUMITA P ASTHANA MD (NPI 1992888739)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992888739 NPI number — SUMITA P ASTHANA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ASTHANA
Provider First Name:
SUMITA
Provider Middle Name:
P
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1992888739
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/19/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 100445
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30384-0445
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
888-627-4702
Provider Business Mailing Address Fax Number:
804-253-0408

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
251 E ANTIETAM ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HAGERSTOWN
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21740-5724
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-279-6234
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  D0064997 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2080N0001X , with the licence number: D0064997 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 3810012596 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4118774 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




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