Healthcare Provider Details

I. General information

NPI: 1033102025
Provider Name (Legal Business Name): GURSEWAK S. SANDHU M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2005
Last Update Date: 09/27/2007
Certification Date:
Deactivation Date: 03/27/2006
Reactivation Date: 04/05/2006

III. Provider practice location address

511 W GROVE ST SUITE 301
MIDDLEBORO MA
02346-1458
US

IV. Provider business mailing address

511 W GROVE ST SUITE 301
MIDDLEBORO MA
02346-1458
US

V. Phone/Fax

Practice location:
  • Phone: 508-947-4634
  • Fax: 508-947-0635
Mailing address:
  • Phone: 508-947-4634
  • Fax: 508-947-0635

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number44829
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: