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General NPI Number Information
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NPI Number | 1083661219
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Entity Type | Individual
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Provider Name | SUSHMA BHASIN M.D.
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Gender | Female
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Dates
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Enumeration Date | 05/31/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 331 OAK MANOR DR
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City | GLEN BURNIE
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State | MD
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Zip | 21061-5508
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Country | US
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Telephone | 410-768-0700
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Fax | 410-768-1143
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Provider Business Mailing Address
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Address Line | 6625 CORINA CT
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City | COLUMBIA
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State | MD
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Zip | 21044-4037
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Country | US
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Telephone | 410-531-6301
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080A0000X
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Taxonomy Name | Pediatric Adolescent Medicine Physician
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License Number | D21268
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License Number State | MD
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