Provider Demographics
NPI:1083818058
Name:AHLUWALIA, GURDEEP (MD)
Entity Type:Individual
Prefix:DR
First Name:GURDEEP
Middle Name:
Last Name:AHLUWALIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 DEFENSE HWY STE 222
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-7071
Mailing Address - Country:US
Mailing Address - Phone:443-716-0420
Mailing Address - Fax:443-716-0419
Practice Address - Street 1:122 DEFENSE HWY STE 222
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401
Practice Address - Country:US
Practice Address - Phone:443-716-0420
Practice Address - Fax:443-716-0419
Is Sole Proprietor?:No
Enumeration Date:2007-06-13
Last Update Date:2023-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD660422084N0400X, 2084N0600X
IN010805812084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDCC1923OtherR/R MEDICARE GROUP #
MD014011200Medicaid
MDP00404659OtherR/R MEDICARE PROVIDER #