Provider Demographics
NPI:1881635845
Name:CHADHA, AMANDEEP SINGH (MD)
Entity Type:Individual
Prefix:DR
First Name:AMANDEEP
Middle Name:SINGH
Last Name:CHADHA
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 1:4345 HARRISON BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84403-3103
Mailing Address - Country:US
Mailing Address - Phone:385-350-8500
Mailing Address - Fax:385-350-8555
Practice Address - Street 1:4345 HARRISON BLVD STE 101
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-3103
Practice Address - Country:US
Practice Address - Phone:385-350-8500
Practice Address - Fax:385-350-8555
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2021-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND9708207R00000X
UT8710941-1205208M00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT8710941-1205OtherUTAH LICENSE
VAD000OtherVA'S UPIN NUMBER
ND13269Medicaid
MN827112700Medicaid
MN827112700Medicaid
ND13269Medicaid