Provider Demographics
NPI:1760473078
Name:DHANDA, GURDARSHAN SINGH (MD)
Entity Type:Individual
Prefix:DR
First Name:GURDARSHAN
Middle Name:SINGH
Last Name:DHANDA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:GORDON
Other - Middle Name:GS
Other - Last Name:DHANDA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:3417 ENSIGN RD NE
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98506-5075
Mailing Address - Country:US
Mailing Address - Phone:360-493-4601
Mailing Address - Fax:360-493-4603
Practice Address - Street 1:3417 ENSIGN RD NE
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506-5075
Practice Address - Country:US
Practice Address - Phone:360-493-4601
Practice Address - Fax:360-493-4603
Is Sole Proprietor?:No
Enumeration Date:2005-11-04
Last Update Date:2010-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000375632085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8251480Medicaid
H06701Medicare UPIN
WA8251480Medicaid