1639195423 NPI number — AMANPREET S. SANDHU MD

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639195423 NPI number — AMANPREET S. SANDHU MD

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

SANDHU

Provider First Name:

AMANPREET

Provider Middle Name:

S.

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

MD

Provider Gender Code:

M

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1639195423

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

01/26/2024

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

8012 BRETZ DR

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

HARRISBURG

Provider Business Mailing Address State Name:

PA

Provider Business Mailing Address Postal Code:

17112-9748

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

Provider Business Mailing Address Fax Number:

Provider First Line Business Practice Location Address:

2005 TECHNOLOGY PKWY STE 245

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

MECHANICSBURG

Provider Business Practice Location Address State Name:

PA

Provider Business Practice Location Address Postal Code:

17050-9413

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

717-791-2850

Provider Business Practice Location Address Fax Number:

717-221-5275

Provider Enumeration Date:

07/14/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 207R00000X , with the licence number:  MD445968 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 207L00000X , with the licence number: MD445968 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 207LP2900X , with the licence number: MD445968 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
• Taxonomy code: 207R00000X , with the licence number: 040624 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

• Identifier: 102725805 0003 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
• Identifier: 102725805 0002 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
• Identifier: 8535447 . This is a "AETNA HMO" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: P010711315 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 002710431 . This is a "HIGHMARK BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 102725805 0001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
• Identifier: 001406249 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
• Identifier: 8535449 . This is a "AETNA HMO" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 7983795 . This is a "AETNA NON HMO" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".