Provider Demographics
NPI:1760487128
Name:SANDHU, FAHEEM A (MD)
Entity Type:Individual
Prefix:
First Name:FAHEEM
Middle Name:A
Last Name:SANDHU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 418283
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-8283
Mailing Address - Country:US
Mailing Address - Phone:703-558-1544
Mailing Address - Fax:
Practice Address - Street 1:10401 HOSPITAL DR
Practice Address - Street 2:STE 101
Practice Address - City:CLINTON
Practice Address - State:MD
Practice Address - Zip Code:20735-3150
Practice Address - Country:US
Practice Address - Phone:301-856-2323
Practice Address - Fax:301-856-0477
Is Sole Proprietor?:No
Enumeration Date:2005-06-14
Last Update Date:2012-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD31717207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCP00856605OtherRAILROAD MEDICARE
MD206794ZBRPMedicare PIN
DCH63051Medicare UPIN
DC171149YT2Medicare PIN