MEDICARE: SUJATA QASBA 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	2080A0000X	Pediatric Adolescent Medicine Physician	D33725	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	213741	OTHER		ALLIANCE PPO
2	7020	OTHER	MD	BLUE CROSS/BLUE SHIELD
3	1200660	OTHER		UNITED HEALTH CARE
4	0100243	OTHER		AETNA HMO
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	72770001	OTHER	DC	BLUE CROSS/BLUE SHIELD
7	0213115	OTHER		CIGNA
8	34269	OTHER		COVENTRY
9	344322	OTHER		NCPPO
10	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
11	813741	OTHER		MAMSI, MDIPA, OPT. CH.

General Provider Information

NPI Number	:	1780682765
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUJATA QASBA M.D.

Provider Business Mailing Address
First Line	:	6302 MORNING DEW CT
Second Line	:
City	:	CLARKSVILLE
State	:	MD
Zip	:	21029-1150
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3450 FORT MEADE RD
Second Line	:	SUITE #103
City	:	LAUREL
State	:	MD
Zip	:	20724-2040
Country	:	US
Telephone Number	:	301-776-2700
Fax Number	:	301-776-4213

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

Provider Enumeration Date	:	07/13/2005
Last Update Date	:	07/09/2007

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Directions to “ SUJATA QASBA M.D.” Practice Location

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