Provider Demographics
NPI:1801885322
Name:DABHIA, GURINDER K (MD)
Entity type:Individual
Prefix:
First Name:GURINDER
Middle Name:K
Last Name:DABHIA
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 1:250 E CHASE AVE
Mailing Address - Street 2:STE 108
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92020-6305
Mailing Address - Country:US
Mailing Address - Phone:301-921-7900
Mailing Address - Fax:301-921-7915
Practice Address - Street 1:1850 TOWN CENTER PKWY
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-3219
Practice Address - Country:US
Practice Address - Phone:703-689-9037
Practice Address - Fax:703-689-9109
Is Sole Proprietor?:No
Enumeration Date:2005-10-18
Last Update Date:2012-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101237307208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010121116Medicaid
VA016012E14Medicare ID - Type Unspecified
MD016012E14Medicare ID - Type Unspecified
I24712Medicare UPIN