Provider Demographics
NPI:1972726420
Name:IQUBAL S. DHALIWAL, M.D.
Entity Type:Organization
Organization Name:IQUBAL S. DHALIWAL, M.D.
Other - Org Name:IQUBAL DHALIWAL
Other - Org Type:Other Name
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:DR
Authorized Official - First Name:IQUBAL
Authorized Official - Middle Name:S
Authorized Official - Last Name:DHALIWAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:508-384-1821
Mailing Address - Street 1:24 COMMON ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:WRENTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02093-1399
Mailing Address - Country:US
Mailing Address - Phone:508-384-1821
Mailing Address - Fax:508-384-0253
Practice Address - Street 1:24 COMMON ST
Practice Address - Street 2:SUITE 3
Practice Address - City:WRENTHAM
Practice Address - State:MA
Practice Address - Zip Code:02093-1399
Practice Address - Country:US
Practice Address - Phone:508-384-1821
Practice Address - Fax:508-384-0253
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2007-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA52229174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA69591OtherHARVARD PILGRIM
MA0075513OtherAETNA
MA0402020OtherUNITED HEALTHCARE
MD712738OtherTUFTS HEALTH PLAN
MA3065391Medicaid
MA4125428OtherCIGNA
MAM17341OtherBLUE CROSS BLUE SHIELD
MADHJ09692Medicare ID - Type Unspecified
MA3065391Medicaid