Provider Demographics
NPI:1316134620
Name:CHIBB, SUMAN
Entity type:Individual
Prefix:
First Name:SUMAN
Middle Name:
Last Name:CHIBB
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 HOOKS LN STE 212
Mailing Address - Street 2:
Mailing Address - City:PIKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-1619
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1001 CATHEDRAL ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-5442
Practice Address - Country:US
Practice Address - Phone:410-752-0954
Practice Address - Fax:410-752-1297
Is Sole Proprietor?:No
Enumeration Date:2007-10-01
Last Update Date:2008-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD14159122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD132190100Medicaid
MDK802Medicare PIN