Provider Demographics
NPI:1184748758
Name:GURDEV S PUREWAL MD,INC
Entity type:Organization
Organization Name:GURDEV S PUREWAL MD,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GURDEV
Authorized Official - Middle Name:S
Authorized Official - Last Name:PUREWAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-723-5780
Mailing Address - Street 1:PO BOX 2438
Mailing Address - Street 2:
Mailing Address - City:WEIRTON
Mailing Address - State:WV
Mailing Address - Zip Code:26062
Mailing Address - Country:US
Mailing Address - Phone:304-723-5780
Mailing Address - Fax:304-723-5939
Practice Address - Street 1:485 COLLIERS WAY
Practice Address - Street 2:
Practice Address - City:WEIRTON
Practice Address - State:WV
Practice Address - Zip Code:26062
Practice Address - Country:US
Practice Address - Phone:304-723-5780
Practice Address - Fax:304-723-5939
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2007-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV11039207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0429562Medicare ID - Type Unspecified
WV4208261Medicare PIN
D49254Medicare UPIN
OH0429565Medicare PIN
OH0429563Medicare ID - Type Unspecified
OH0429564Medicare ID - Type Unspecified