Provider Demographics
NPI:1770010399
Name:SANDHU, GURKIRAT SINGH (MD)
Entity type:Individual
Prefix:MR
First Name:GURKIRAT
Middle Name:SINGH
Last Name:SANDHU
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 415348
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-5348
Mailing Address - Country:US
Mailing Address - Phone:800-225-8885
Mailing Address - Fax:508-334-1977
Practice Address - Street 1:320 POMFRET ST
Practice Address - Street 2:
Practice Address - City:PUTNAM
Practice Address - State:CT
Practice Address - Zip Code:06260-1836
Practice Address - Country:US
Practice Address - Phone:860-928-6541
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-13
Last Update Date:2024-09-13
Deactivation Date:2017-12-18
Deactivation Code:
Reactivation Date:2017-12-26
Provider Licenses
StateLicense IDTaxonomies
CT64259207R00000X
MA1020309207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine