Provider Demographics
NPI:1780682765
Name:QASBA, SUJATA (MD)
Entity Type:Individual
Prefix:
First Name:SUJATA
Middle Name:
Last Name:QASBA
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 1:6302 MORNING DEW CT
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21029-1150
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3450 FORT MEADE RD
Practice Address - Street 2:SUITE #103
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20724-2040
Practice Address - Country:US
Practice Address - Phone:301-776-2700
Practice Address - Fax:301-776-4213
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD337252080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
213741OtherALLIANCE PPO
MD7020OtherBLUE CROSS/BLUE SHIELD
1200660OtherUNITED HEALTH CARE
0100243OtherAETNA HMO
MD1200660Medicaid
DC72770001OtherBLUE CROSS/BLUE SHIELD
0213115OtherCIGNA
34269OtherCOVENTRY
344322OtherNCPPO
MD07978Medicaid
813741OtherMAMSI, MDIPA, OPT. CH.