Provider Demographics
NPI:1932195724
Name:PUREWAL, AMANDEEP SINGH (MD)
Entity Type:Individual
Prefix:
First Name:AMANDEEP
Middle Name:SINGH
Last Name:PUREWAL
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 1:485 COLLIERS WAY
Mailing Address - Street 2:SUITE B
Mailing Address - City:WEIRTON
Mailing Address - State:WV
Mailing Address - Zip Code:26062-5012
Mailing Address - Country:US
Mailing Address - Phone:304-723-4041
Mailing Address - Fax:304-723-9607
Practice Address - Street 1:485 COLLIERS WAY
Practice Address - Street 2:SUITE B
Practice Address - City:WEIRTON
Practice Address - State:WV
Practice Address - Zip Code:26062-5012
Practice Address - Country:US
Practice Address - Phone:304-723-4041
Practice Address - Fax:304-723-9607
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-27
Last Update Date:2008-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV19873207RG0100X
OH35077279P207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV6000228000Medicaid
OH2165740Medicaid
WVH00263Medicare UPIN
WV0885921Medicare PIN