Provider Demographics
NPI:1487628897
Name:SANDHU, PREETINDER SINGH (MD)
Entity Type:Individual
Prefix:
First Name:PREETINDER
Middle Name:SINGH
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:PO BOX 1972
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21041-1972
Mailing Address - Country:US
Mailing Address - Phone:410-362-4481
Mailing Address - Fax:410-362-3647
Practice Address - Street 1:1940 WEST BALTIMORE STREET
Practice Address - Street 2:
Practice Address - City:BALTIMORE CITY
Practice Address - State:MD
Practice Address - Zip Code:21223
Practice Address - Country:US
Practice Address - Phone:410-362-4481
Practice Address - Fax:410-362-3647
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-14
Last Update Date:2013-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0057543207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD368SOtherMEDICARE PROVIDER
MDMA778204700Medicaid
MD368SOtherMEDICARE PROVIDER