Healthcare Provider Details

I. General information

NPI: 1114365152
Provider Name (Legal Business Name): RAJNI SANDHU MARCO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RAJNI KAUR SANDHU M.D.

II. Dates (important events)

Enumeration Date: 06/12/2013
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1826 W ARLINGTON BLVD CHILDREN'S HEALTH SERVICES, PA
GREENVILLE NC
27834-5704
US

IV. Provider business mailing address

9059 W. LAKE PLEASANT PKWY STE E-540
PEORIA AZ
85382
US

V. Phone/Fax

Practice location:
  • Phone: 252-329-7337
  • Fax: 252-329-1477
Mailing address:
  • Phone: 623-322-3380
  • Fax: 623-322-4399

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2016-01573
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: