Provider Demographics
NPI:1538349782
Name:DR. GHOUSIA SULTANA, M.D, P.A.
Entity type:Organization
Organization Name:DR. GHOUSIA SULTANA, M.D, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICIAL
Authorized Official - Prefix:MR
Authorized Official - First Name:TAIYAB
Authorized Official - Middle Name:M
Authorized Official - Last Name:MOHIUDDIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-949-7000
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-05
Last Update Date:2007-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD56691207RH0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD699564100Medicaid
G01626D01Medicare PIN