Provider Demographics
NPI:1942225040
Name:DHILLON, SANDEEP K (MD)
Entity Type:Individual
Prefix:
First Name:SANDEEP
Middle Name:K
Last Name:DHILLON
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 1:41 MALL RD.
Mailing Address - Street 2:LAHEY CLINIC
Mailing Address - City:BURLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01805
Mailing Address - Country:US
Mailing Address - Phone:781-744-2086
Mailing Address - Fax:781-744-5236
Practice Address - Street 1:41 MALL RD.
Practice Address - Street 2:LAHEY CLINIC
Practice Address - City:BURLINGTON
Practice Address - State:MA
Practice Address - Zip Code:01805
Practice Address - Country:US
Practice Address - Phone:781-744-2086
Practice Address - Fax:781-744-5236
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2011-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH11308207R00000X
MA233605207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30201541Medicaid
MA2146029Medicaid
MA000354001Medicare PIN
G97220Medicare UPIN