Provider Demographics
NPI:1093054298
Name:PREETINDER S. SANDHU, MD, LLC
Entity Type:Organization
Organization Name:PREETINDER S. SANDHU, MD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PREETINDER
Authorized Official - Middle Name:SINGH
Authorized Official - Last Name:SANDHU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-362-4481
Mailing Address - Street 1:821 N EUTAW ST STE 305
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201-6303
Mailing Address - Country:US
Mailing Address - Phone:410-362-4481
Mailing Address - Fax:410-362-3647
Practice Address - Street 1:821 N EUTAW ST STE 305
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-6303
Practice Address - Country:US
Practice Address - Phone:410-362-4481
Practice Address - Fax:410-362-3647
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-07
Last Update Date:2021-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0057543207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD778204700Medicaid
MD778204700Medicaid