Provider Demographics
NPI:1649205238
Name:JASSI, SUKHPAL I (MD)
Entity Type:Individual
Prefix:DR
First Name:SUKHPAL
Middle Name:I
Last Name:JASSI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 HOSPITAL DR STE 205
Mailing Address - Street 2:
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061-5807
Mailing Address - Country:US
Mailing Address - Phone:443-410-3161
Mailing Address - Fax:443-410-3199
Practice Address - Street 1:325 HOSPITAL DR STE 205
Practice Address - Street 2:
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061
Practice Address - Country:US
Practice Address - Phone:443-410-3161
Practice Address - Fax:443-410-3199
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2021-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0054292207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD681000400Medicaid
MDH982624XMedicare ID - Type Unspecified