Provider Demographics
NPI:1023570132
Name:SUSHMA BHASIN
Entity Type:Organization
Organization Name:SUSHMA BHASIN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSHMA
Authorized Official - Middle Name:
Authorized Official - Last Name:BHASIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-768-0700
Mailing Address - Street 1:331 OAK MANOR DR STE 203
Mailing Address - Street 2:
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061-5555
Mailing Address - Country:US
Mailing Address - Phone:410-768-0700
Mailing Address - Fax:410-768-1143
Practice Address - Street 1:331 OAK MANOR DR STE 203
Practice Address - Street 2:
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-5555
Practice Address - Country:US
Practice Address - Phone:410-768-0700
Practice Address - Fax:410-768-1143
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-05
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1083661219Medicaid