Provider Demographics
NPI:1467502211
Name:SANDHU, GURINDER PAUL (MD)
Entity Type:Individual
Prefix:DR
First Name:GURINDER
Middle Name:PAUL
Last Name:SANDHU
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 1:260 HWY 43 N
Mailing Address - Street 2:
Mailing Address - City:VANCEBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28586
Mailing Address - Country:US
Mailing Address - Phone:252-244-4700
Mailing Address - Fax:252-244-4702
Practice Address - Street 1:260 HWY 43 N
Practice Address - Street 2:
Practice Address - City:VANCEBORO
Practice Address - State:NC
Practice Address - Zip Code:28586
Practice Address - Country:US
Practice Address - Phone:252-244-4700
Practice Address - Fax:252-244-4702
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9601712207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2265744AOtherMEDICARE LEGACY
NC1106LOtherNC BCBS
NCP00015352OtherRR MEDICARE
NC891106LMedicaid
NC891106LMedicaid