Provider Demographics
NPI:1205836798
Name:SANDHU, MANDEEP (MD)
Entity Type:Individual
Prefix:DR
First Name:MANDEEP
Middle Name:
Last Name:SANDHU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19415 DEERFIELD AVE
Mailing Address - Street 2:SUITE 115
Mailing Address - City:LANSDOWNE
Mailing Address - State:VA
Mailing Address - Zip Code:20176-8452
Mailing Address - Country:US
Mailing Address - Phone:703-729-2626
Mailing Address - Fax:703-729-3141
Practice Address - Street 1:19415 DEERFIELD AVE
Practice Address - Street 2:SUITE 115
Practice Address - City:LANSDOWNE
Practice Address - State:VA
Practice Address - Zip Code:20176-8452
Practice Address - Country:US
Practice Address - Phone:703-729-2626
Practice Address - Fax:703-729-3141
Is Sole Proprietor?:No
Enumeration Date:2005-07-26
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101221173207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA236002OtherANTHEM
P00311835OtherMEDICARE RAILROAD
VA5865557Medicaid
VA5865557Medicaid