Provider Demographics
NPI:1790878528
Name:MARWAH, DHARMINDER S (MD)
Entity Type:Individual
Prefix:
First Name:DHARMINDER
Middle Name:S
Last Name:MARWAH
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 1:612 W BASELINE RD
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85210-6041
Mailing Address - Country:US
Mailing Address - Phone:480-834-9039
Mailing Address - Fax:480-964-7802
Practice Address - Street 1:612 W BASELINE RD
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85210-6041
Practice Address - Country:US
Practice Address - Phone:480-834-9039
Practice Address - Fax:480-964-7802
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2012-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ24331207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ350108Medicaid
AZ61963Medicare ID - Type Unspecified
G06175Medicare UPIN