Provider Demographics
NPI:1891979605
Name:DHAWAN, SURINDER (MD)
Entity Type:Individual
Prefix:DR
First Name:SURINDER
Middle Name:
Last Name:DHAWAN
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 2669
Mailing Address - Street 2:1024 S. HORNER BLVD
Mailing Address - City:SANFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27331-2669
Mailing Address - Country:US
Mailing Address - Phone:919-774-3680
Mailing Address - Fax:919-774-3682
Practice Address - Street 1:1024 S. HORNER BOULEVARD
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:NC
Practice Address - Zip Code:27330-4151
Practice Address - Country:US
Practice Address - Phone:919-774-3680
Practice Address - Fax:919-774-3682
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-28
Last Update Date:2013-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9701318207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89129COMedicaid
H08882Medicare UPIN
NC89129COMedicaid