Basic Information
| Provider Information | |||||||||
| NPI: | 1073610127 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ASTHMA ALLERGY AND SINUS CENTER, LLC | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | |||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 3600 LEONARDTOWN ROAD | ||||||||
| Address2: | SUITE 103 | ||||||||
| City: | WALDORF | ||||||||
| State: | MD | ||||||||
| PostalCode: | 20601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3018432223 | ||||||||
| FaxNumber: | 3017059720 | ||||||||
| Practice Location | |||||||||
| Address1: | 3600 LEONARDTOWN ROAD | ||||||||
| Address2: | SUITE 103 | ||||||||
| City: | WALDORF | ||||||||
| State: | MD | ||||||||
| PostalCode: | 20601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3018432223 | ||||||||
| FaxNumber: | 3017059720 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/20/2006 | ||||||||
| LastUpdateDate: | 05/07/2020 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | SEKHSARIA | ||||||||
| AuthorizedOfficialFirstName: | SUDHIR | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | OWNER/PHYSICIAN | ||||||||
| AuthorizedOfficialTelephone: | 3018432223 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 05/07/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261Q00000X | D38016 | MD | N | Ambulatory Health Care Facilities | Clinic/Center | 261Q00000X | D46292 | MD | Y | Ambulatory Health Care Facilities | Clinic/Center |
ID Information
| ID | Type | State | Issuer | Description | 371M | 01 | MD | MEDICARE | OTHER | 357046100 | 05 | MD | MEDICAID | P00014305 | 01 | MD | RAILROAD MEDICARE | OTHER | DA4048 | 01 | MD | RAILROAD MEDICARE | OTHER |