Provider Demographics
NPI:1104945070
Name:SARPHARE, GEETA S (PHD)
Entity type:Individual
Prefix:DR
First Name:GEETA
Middle Name:S
Last Name:SARPHARE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3905 NATIONAL DR STE 230
Mailing Address - Street 2:
Mailing Address - City:BURTONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20866-6101
Mailing Address - Country:US
Mailing Address - Phone:301-256-5243
Mailing Address - Fax:443-583-3872
Practice Address - Street 1:3905 NATIONAL DR STE 230
Practice Address - Street 2:
Practice Address - City:BURTONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20866-6101
Practice Address - Country:US
Practice Address - Phone:301-256-5243
Practice Address - Fax:443-923-3872
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD03945101YM0800X, 103TB0200X, 103TM1800X, 103TC2200X
MDLBA1750103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD780063Medicaid