1780682765 NPI number — SUJATA QASBA M.D.

Table of content: SUJATA QASBA M.D. (NPI 1780682765)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780682765 NPI number — SUJATA QASBA M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
QASBA
Provider First Name:
SUJATA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1780682765
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6302 MORNING DEW CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLARKSVILLE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21029-1150
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3450 FORT MEADE RD
Provider Second Line Business Practice Location Address:
SUITE #103
Provider Business Practice Location Address City Name:
LAUREL
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20724-2040
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-776-2700
Provider Business Practice Location Address Fax Number:
301-776-4213
Provider Enumeration Date:
07/13/2005

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: 2080A0000X , with the licence number:  D33725 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 213741 . This is a "ALLIANCE PPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7020 . This is a "BLUE CROSS/BLUE SHIELD" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 1200660 . This is a "UNITED HEALTH CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0100243 . This is a "AETNA HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1200660 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 72770001 . This is a "BLUE CROSS/BLUE SHIELD" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: 0213115 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 34269 . This is a "COVENTRY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 344322 . This is a "NCPPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 07978 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 813741 . This is a "MAMSI, MDIPA, OPT. CH." identifier . This identifiers is of the category "OTHER".




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