Provider Demographics
NPI:1669660023
Name:GURSEWAK S. SANDHU, MD, PC
Entity Type:Organization
Organization Name:GURSEWAK S. SANDHU, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GURSEWAK
Authorized Official - Middle Name:S
Authorized Official - Last Name:SANDHU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:508-947-4634
Mailing Address - Street 1:511 W GROVE ST
Mailing Address - Street 2:SUITE 301
Mailing Address - City:MIDDLEBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02346-1458
Mailing Address - Country:US
Mailing Address - Phone:508-947-4634
Mailing Address - Fax:508-947-0635
Practice Address - Street 1:511 W GROVE ST
Practice Address - Street 2:SUITE 301
Practice Address - City:MIDDLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02346-1458
Practice Address - Country:US
Practice Address - Phone:508-947-4634
Practice Address - Fax:508-947-0635
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-11
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA44829207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0109568Medicaid
MAGUM13473OtherBLUE CROSS BLUE SHIELD
MA9722203Medicaid
MAGUM13473OtherBLUE CROSS BLUE SHIELD
MAM13473Medicare PIN