Provider Demographics
NPI:1467487025
Name:DEOL, GURVINDER S (MD)
Entity Type:Individual
Prefix:DR
First Name:GURVINDER
Middle Name:S
Last Name:DEOL
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 1:2920 HIGHWOODS BLVD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27604-0010
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3009 NEW BERN AVE
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27610-1214
Practice Address - Country:US
Practice Address - Phone:919-232-5020
Practice Address - Fax:919-232-5021
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2021-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200400487207XS0117X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP00347233OtherRAILROAD MEDICARE
IL036106684Medicaid
IL0371240002Medicare NSC
ILH20502Medicare UPIN
IL036106684Medicaid