Provider Demographics
NPI:1336173277
Name:CHHABRA, GURDEEP
Entity Type:Individual
Prefix:
First Name:GURDEEP
Middle Name:
Last Name:CHHABRA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23415 THREE NOTCH RD STE 2050
Mailing Address - Street 2:
Mailing Address - City:CALIFORNIA
Mailing Address - State:MD
Mailing Address - Zip Code:20619-4018
Mailing Address - Country:US
Mailing Address - Phone:301-373-7800
Mailing Address - Fax:301-373-6800
Practice Address - Street 1:23415 THREE NOTCH RD STE 2050
Practice Address - Street 2:
Practice Address - City:CALIFORNIA
Practice Address - State:MD
Practice Address - Zip Code:20619-4018
Practice Address - Country:US
Practice Address - Phone:301-373-7800
Practice Address - Fax:301-373-6800
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2021-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0050686207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD354300500Medicaid
MD830006765OtherMEDICARE RAILROAD
MD354300500Medicaid
DC00A660G99Medicare PIN