Provider Demographics
NPI:1538608864
Name:KASASA, BETTY
Entity type:Individual
Prefix:
First Name:BETTY
Middle Name:
Last Name:KASASA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8212 BRINK RD
Mailing Address - Street 2:
Mailing Address - City:LAYTONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20882-4858
Mailing Address - Country:US
Mailing Address - Phone:301-537-6838
Mailing Address - Fax:301-569-7940
Practice Address - Street 1:8212 BRINK RD
Practice Address - Street 2:
Practice Address - City:LAYTONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20882-4858
Practice Address - Country:US
Practice Address - Phone:301-537-6838
Practice Address - Fax:301-569-7940
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-20
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD81-5381734332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies