MEDICARE: FAHEEM A . SANDHU M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207T00000X	Neurological Surgery Physician	MD31717	DC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00856605	OTHER	DC	RAILROAD MEDICARE

General Provider Information

NPI Number	:	1760487128
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FAHEEM A . SANDHU M.D.

Provider Business Mailing Address
First Line	:	PO BOX 418283
Second Line	:
City	:	BOSTON
State	:	MA
Zip	:	02241-8283
Country	:	US
Telephone Number	:	703-558-1544
Fax Number	:

Provider Business Practice Location Address
First Line	:	10401 HOSPITAL DR
Second Line	:	STE 101
City	:	CLINTON
State	:	MD
Zip	:	20735-3150
Country	:	US
Telephone Number	:	301-856-2323
Fax Number	:	301-856-0477

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/14/2005
Last Update Date	:	03/14/2012

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