1992276430 NPI number — SUJATA QASBA, MD

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992276430 NPI number — SUJATA QASBA, MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SUJATA QASBA, MD
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1992276430
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/10/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3450 FORT MEADE RD STE 107
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAUREL
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20724-2040
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-776-2700
Provider Business Mailing Address Fax Number:
301-776-2700

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3450 FORT MEADE RD STE 107
Provider Second Line Business Practice Location Address:
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:
301-776-2700
Provider Enumeration Date:
12/10/2018

Additional Information

Authorized Official

Authorized Official Last Name:
QASBA
Authorized Official First Name:
SUJATA
Authorized Official Middle Name:
KAW
Authorized Official Title or Position:
PHYSICIAN
Authorized Official Telephone Number:
301-776-2700

Provider Taxonomy Codes

  • Taxonomy code: 208000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1780682765 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




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