Provider Demographics
NPI:1730383571
Name:KABA, SUELA (MD)
Entity type:Individual
Prefix:DR
First Name:SUELA
Middle Name:
Last Name:KABA
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 1:6934 AVIATION BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061-2593
Mailing Address - Country:US
Mailing Address - Phone:443-949-0814
Mailing Address - Fax:443-949-0825
Practice Address - Street 1:6934 AVIATION BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-2593
Practice Address - Country:US
Practice Address - Phone:443-949-0814
Practice Address - Fax:443-949-0825
Is Sole Proprietor?:No
Enumeration Date:2007-06-14
Last Update Date:2013-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MDD70277207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD6436421OtherAETNA HMO
MD968920-01OtherCAREFIRST BCBS OF MARYLAND
MDP19415OtherCAREFIRST BCBS POS
MD239897OtherJHHC PRIORITY PARTNERS
MD420211200Medicaid
MD0113OtherCAREFIRST BLUE CHOICE
MD9273557OtherAETNA PPO
MD239897OtherJHHC PRIORITY PARTNERS