Provider Demographics
NPI:1861451361
Name:KAZMI, SIBTE ABBAS (MD)
Entity Type:Individual
Prefix:
First Name:SIBTE
Middle Name:ABBAS
Last Name:KAZMI
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 1:814 TOLL HOUSE AVE
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21701-4519
Mailing Address - Country:US
Mailing Address - Phone:301-662-8310
Mailing Address - Fax:301-662-1209
Practice Address - Street 1:814 TOLL HOUSE AVE
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21701
Practice Address - Country:US
Practice Address - Phone:301-662-8310
Practice Address - Fax:301-662-1209
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-22
Last Update Date:2010-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0047951207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD62405902OtherBCBS
MDP00154563OtherRAILROAD
MD403826600Medicaid
MDG03013Medicare UPIN
MDP00154563OtherRAILROAD