Provider Demographics
NPI:1578904504
Name:DHILLON, GURDIAL (MD)
Entity Type:Individual
Prefix:
First Name:GURDIAL
Middle Name:
Last Name:DHILLON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2559 MEDICAL DR
Mailing Address - Street 2:STE D
Mailing Address - City:ALAMOGORDO
Mailing Address - State:NM
Mailing Address - Zip Code:88310-8704
Mailing Address - Country:US
Mailing Address - Phone:575-434-2229
Mailing Address - Fax:575-439-5705
Practice Address - Street 1:245 N 15TH ST # MS 495
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19102-1101
Practice Address - Country:US
Practice Address - Phone:215-762-8220
Practice Address - Fax:215-762-1470
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-05
Last Update Date:2017-07-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NMMD2017-0292207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology