Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | D21268 | MD |
NPI | 1083661219 |
---|---|
Provider Name | Sushma Bhasin |
First Address | Columbia, MD 21044-4037 |
Second Address | Glen Burnie, MD 21061-5508 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/05/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B70665 | (02) | MD |