Healthcare Provider Details

I. General information

NPI: 1538349782
Provider Name (Legal Business Name): DR. GHOUSIA SULTANA, M.D, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2007
Last Update Date: 11/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12107 HERITAGE PARK CIR
SILVER SPRING MD
20906-4555
US

IV. Provider business mailing address

12107 HERITAGE PARK CIR
SILVER SPRING MD
20906-4555
US

V. Phone/Fax

Practice location:
  • Phone: 301-949-7000
  • Fax: 301-949-7029
Mailing address:
  • Phone: 301-949-7000
  • Fax: 301-949-7029

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0000X
TaxonomyHematology (Internal Medicine) Physician
License NumberD56691
License Number StateMD

VIII. Authorized Official

Name: MR. TAIYAB M MOHIUDDIN
Title or Position: OFFICIAL
Credential:
Phone: 301-949-7000