Provider Demographics
NPI:1891896601
Name:SANDHU, SIMRAN (MD)
Entity Type:Individual
Prefix:
First Name:SIMRAN
Middle Name:
Last Name:SANDHU
Suffix:
Gender:F
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 37619
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21297-3619
Mailing Address - Country:US
Mailing Address - Phone:443-917-2855
Mailing Address - Fax:410-346-5775
Practice Address - Street 1:10700 CHARTER DR
Practice Address - Street 2:SUITE 110
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-3629
Practice Address - Country:US
Practice Address - Phone:443-917-2855
Practice Address - Fax:410-346-5775
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2015-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2372532085R0202X
MDD681372085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDD68137OtherMARYLAND LICENSE
NY237253OtherNY LICENSE