Healthcare Provider Details

I. General information

NPI: 1811153489
Provider Name (Legal Business Name): MANDEEP HUNDAL M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2008
Last Update Date: 12/31/2019
Certification Date: 12/31/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 HOSPITAL RD STE 2A
LEOMINSTER MA
01453-2253
US

IV. Provider business mailing address

PO BOX 726
LEOMINSTER MA
01453-0726
US

V. Phone/Fax

Practice location:
  • Phone: 978-466-2692
  • Fax: 978-466-4754
Mailing address:
  • Phone: 774-420-2642
  • Fax: 774-420-2283

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number247723
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number042-0011851
License Number StateVT
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number247723
License Number StateMA
# 4
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number247723
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: