Provider Demographics
NPI:1386670461
Name:KANWAL, GUCHARAN S (MD)
Entity Type:Individual
Prefix:DR
First Name:GUCHARAN
Middle Name:S
Last Name:KANWAL
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:PO BOX 1136
Mailing Address - Street 2:116 CENTER ST
Mailing Address - City:NORTON
Mailing Address - State:VA
Mailing Address - Zip Code:24273-0905
Mailing Address - Country:US
Mailing Address - Phone:276-395-6244
Mailing Address - Fax:276-395-3058
Practice Address - Street 1:116 CENTRE AVE NE
Practice Address - Street 2:
Practice Address - City:COEBURN
Practice Address - State:VA
Practice Address - Zip Code:24230-4033
Practice Address - Country:US
Practice Address - Phone:276-395-6244
Practice Address - Fax:276-395-3058
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2012-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA010102217207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAV V5974AMedicare PIN
B06287Medicare UPIN
VAP00336124Medicare PIN
VA010531W82Medicare PIN