Provider Demographics
NPI:1629455340
Name:GREWAL, GAGANDEEP SINGH
Entity Type:Individual
Prefix:MR
First Name:GAGANDEEP
Middle Name:SINGH
Last Name:GREWAL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1034 GROVE ST
Mailing Address - Street 2:
Mailing Address - City:MEADVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16335-2945
Mailing Address - Country:US
Mailing Address - Phone:814-373-4270
Mailing Address - Fax:814-373-4273
Practice Address - Street 1:765 LIBERTY ST STE 307-A
Practice Address - Street 2:
Practice Address - City:MEADVILLE
Practice Address - State:PA
Practice Address - Zip Code:16335-2566
Practice Address - Country:US
Practice Address - Phone:814-373-4270
Practice Address - Fax:814-373-4273
Is Sole Proprietor?:No
Enumeration Date:2015-05-01
Last Update Date:2023-08-15
Deactivation Date:2015-12-09
Deactivation Code:
Reactivation Date:2016-07-20
Provider Licenses
StateLicense IDTaxonomies
PAMD469454207RE0101X, 207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism