Provider Demographics
NPI:1518587138
Name:KOMALDEEP KAUR, FNU (MD)
Entity Type:Individual
Prefix:
First Name:FNU
Middle Name:
Last Name:KOMALDEEP KAUR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KOMALDEEP
Other - Middle Name:
Other - Last Name:KAUR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:120 BRENTWOOD COMMONS WAY STE 510
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027
Mailing Address - Country:US
Mailing Address - Phone:615-371-4431
Mailing Address - Fax:610-447-6373
Practice Address - Street 1:ONE MEDICAL CENTER BOULEVARD
Practice Address - Street 2:DEPARTMENT OF MEDICINE, 3 EAST, CROZER CHESTER MEDICAL
Practice Address - City:UPLAND
Practice Address - State:PA
Practice Address - Zip Code:19013-3995
Practice Address - Country:US
Practice Address - Phone:610-874-6114
Practice Address - Fax:610-447-6373
Is Sole Proprietor?:No
Enumeration Date:2020-04-23
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
SC89663207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program