Healthcare Provider Details

I. General information

NPI: 1780682765
Provider Name (Legal Business Name): SUJATA QASBA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2005
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3450 FORT MEADE RD SUITE #103
LAUREL MD
20724-2040
US

IV. Provider business mailing address

6302 MORNING DEW CT
CLARKSVILLE MD
21029-1150
US

V. Phone/Fax

Practice location:
  • Phone: 301-776-2700
  • Fax: 301-776-4213
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License NumberD33725
License Number StateMD

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier213741
Identifier TypeOTHER
Identifier State
Identifier IssuerALLIANCE PPO
# 2
Identifier7020
Identifier TypeOTHER
Identifier StateMD
Identifier IssuerBLUE CROSS/BLUE SHIELD
# 3
Identifier1200660
Identifier TypeOTHER
Identifier State
Identifier IssuerUNITED HEALTH CARE
# 4
Identifier0100243
Identifier TypeOTHER
Identifier State
Identifier IssuerAETNA HMO
# 5
Identifier1200660
Identifier TypeMEDICAID
Identifier StateMD
Identifier Issuer
# 6
Identifier72770001
Identifier TypeOTHER
Identifier StateDC
Identifier IssuerBLUE CROSS/BLUE SHIELD
# 7
Identifier0213115
Identifier TypeOTHER
Identifier State
Identifier IssuerCIGNA
# 8
Identifier34269
Identifier TypeOTHER
Identifier State
Identifier IssuerCOVENTRY
# 9
Identifier344322
Identifier TypeOTHER
Identifier State
Identifier IssuerNCPPO
# 10
Identifier07978
Identifier TypeMEDICAID
Identifier StateMD
Identifier Issuer
# 11
Identifier813741
Identifier TypeOTHER
Identifier State
Identifier IssuerMAMSI, MDIPA, OPT. CH.

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: