Basic Information
| Provider Information | |||||||||
| NPI: | 1730383571 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KABA | ||||||||
| FirstName: | SUELA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6934 AVIATION BLVD | ||||||||
| Address2: | SUITE B | ||||||||
| City: | GLEN BURNIE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210612593 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4439490814 | ||||||||
| FaxNumber: | 4439490825 | ||||||||
| Practice Location | |||||||||
| Address1: | 6934 AVIATION BLVD | ||||||||
| Address2: | SUITE B | ||||||||
| City: | GLEN BURNIE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210612593 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4439490814 | ||||||||
| FaxNumber: | 4439490825 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/14/2007 | ||||||||
| LastUpdateDate: | 02/24/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207Q00000X | D70277 | MD | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 6436421 | 01 | MD | AETNA HMO | OTHER | 968920-01 | 01 | MD | CAREFIRST BCBS OF MARYLAND | OTHER | P19415 | 01 | MD | CAREFIRST BCBS POS | OTHER | 239897 | 01 | MD | JHHC PRIORITY PARTNERS | OTHER | 420211200 | 05 | MD | MEDICAID | 0113 | 01 | MD | CAREFIRST BLUE CHOICE | OTHER | 9273557 | 01 | MD | AETNA PPO | OTHER |