Provider Demographics
NPI:1992276430
Name:SUJATA QASBA, MD
Entity type:Organization
Organization Name:SUJATA QASBA, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:SUJATA
Authorized Official - Middle Name:KAW
Authorized Official - Last Name:QASBA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-776-2700
Mailing Address - Street 1:3450 FORT MEADE RD STE 107
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20724-2040
Mailing Address - Country:US
Mailing Address - Phone:301-776-2700
Mailing Address - Fax:301-776-2700
Practice Address - Street 1:3450 FORT MEADE RD STE 107
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20724-2040
Practice Address - Country:US
Practice Address - Phone:301-776-2700
Practice Address - Fax:301-776-2700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-10
Last Update Date:2018-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1780682765Medicaid