Provider Demographics
NPI: | 1821088204 |
---|---|
Name: | SIDHU, GURMEET S (MD) |
Entity Type: | Individual |
Prefix: | |
First Name: | GURMEET |
Middle Name: | S |
Last Name: | SIDHU |
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: | 3001 HOSPITAL DR, DEPT OF RADIOLOGY |
Mailing Address - Street 2: | |
Mailing Address - City: | CHEVERLY |
Mailing Address - State: | MD |
Mailing Address - Zip Code: | 20785-1189 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 301-618-3340 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 3001 HOSPITAL DR, DEPT OF RADIOLOGY |
Practice Address - Street 2: | |
Practice Address - City: | CHEVERLY |
Practice Address - State: | MD |
Practice Address - Zip Code: | 20785-1189 |
Practice Address - Country: | US |
Practice Address - Phone: | 301-618-3340 |
Practice Address - Fax: | |
Is Sole Proprietor?: | No |
Enumeration Date: | 2005-10-26 |
Last Update Date: | 2019-04-26 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
MD | D31683 | 2085R0202X, 2085R0204X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 2085R0204X | Allopathic & Osteopathic Physicians | Radiology | Vascular & Interventional Radiology |
No | 2085R0202X | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
MD | 484011900 | Medicaid | |
DC | 024892400 | Medicaid | |
C88511 | Medicare UPIN |