Basic Information
Provider Information
NPI: 1811239163
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: DHILLON
FirstName: GAGANDEEP
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 500 UNIVERSITY DR
Address2: MC H073
City: HERSHEY
State: PA
PostalCode: 170332360
CountryCode: US
TelephoneNumber: 7175310003
FaxNumber: 7175316491
Practice Location
Address1: 500 UNIVERSITY DR
Address2: MC H073
City: HERSHEY
State: PA
PostalCode: 170332360
CountryCode: US
TelephoneNumber: 7175310003
FaxNumber: 7175316491
Other Information
ProviderEnumerationDate: 03/25/2013
LastUpdateDate: 12/16/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
390200000X  Y Student, Health CareStudent in an Organized Health Care Education/Training Program 

No ID Information.


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