Healthcare Provider Details

I. General information

NPI: 1134260482
Provider Name (Legal Business Name): HARJINDER K VIRDEE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2704 N BROADWAY SUITE C
FARGO ND
58102
US

IV. Provider business mailing address

2704 N BROADWAY SUITE C
FARGO ND
58102
US

V. Phone/Fax

Practice location:
  • Phone: 701-232-3100
  • Fax:
Mailing address:
  • Phone: 701-232-3100
  • Fax: 701-232-3135

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number6528
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: