Provider Demographics
NPI:1417248253
Name:QASBA, NEENA TICKU (MD)
Entity type:Individual
Prefix:
First Name:NEENA
Middle Name:TICKU
Last Name:QASBA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:263 FARMINGTON AVENUE
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06030-8085
Mailing Address - Country:US
Mailing Address - Phone:860-679-2792
Mailing Address - Fax:860-679-1494
Practice Address - Street 1:263 FARMINGTON AVENUE
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06030-8085
Practice Address - Country:US
Practice Address - Phone:860-679-2792
Practice Address - Fax:860-679-1494
Is Sole Proprietor?:No
Enumeration Date:2011-04-27
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA271176207V00000X
CT053717207V00000X, 207VC0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VC0300XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyComplex Family Planning
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology