Provider Demographics
NPI:1346294279
Name:SULTANA, GHOUSIA (MD)
Entity Type:Individual
Prefix:DR
First Name:GHOUSIA
Middle Name:
Last Name:SULTANA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12107 HERITAGE PARK CIR
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20906-4555
Mailing Address - Country:US
Mailing Address - Phone:301-949-7000
Mailing Address - Fax:301-949-7029
Practice Address - Street 1:12107 HERITAGE PARK CIR
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20906-4555
Practice Address - Country:US
Practice Address - Phone:301-949-7000
Practice Address - Fax:301-949-7029
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2007-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD56691207RH0000X
DCMD32208207RH0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematology
Provider Identifiers
StateIdentifier IDID TypeIssuer
G01626Medicare PIN
MDH52311Medicare UPIN