MEDICARE: DR. SUELA KABA M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program
2	207Q00000X	Family Medicine Physician	D70277	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	6436421	OTHER	MD	AETNA HMO
2	968920-01	OTHER	MD	CAREFIRST BCBS OF MARYLAND
3	P19415	OTHER	MD	CAREFIRST BCBS POS
4	239897	OTHER	MD	JHHC PRIORITY PARTNERS
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	0113	OTHER	MD	CAREFIRST BLUE CHOICE
7	9273557	OTHER	MD	AETNA PPO

General Provider Information

NPI Number	:	1730383571
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUELA KABA M.D.

Provider Business Mailing Address
First Line	:	6934 AVIATION BLVD
Second Line	:	SUITE B
City	:	GLEN BURNIE
State	:	MD
Zip	:	21061-2593
Country	:	US
Telephone Number	:	443-949-0814
Fax Number	:	443-949-0825

Provider Business Practice Location Address
First Line	:	6934 AVIATION BLVD
Second Line	:	SUITE B
City	:	GLEN BURNIE
State	:	MD
Zip	:	21061-2593
Country	:	US
Telephone Number	:	443-949-0814
Fax Number	:	443-949-0825

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/14/2007
Last Update Date	:	02/24/2013

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