Healthcare Provider Details

I. General information

NPI: 1902289663
Provider Name (Legal Business Name): GURPREET KAUR D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2015
Last Update Date: 09/08/2020
Certification Date: 09/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8020 LIBERTY WAY
WEST CHESTER OH
45069-2519
US

IV. Provider business mailing address

830 WASHINGTON ST
WATERTOWN NY
13601-4034
US

V. Phone/Fax

Practice location:
  • Phone: 513-777-8300
  • Fax: 513-777-0431
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberOT016262
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOT016262
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: