Basic Information
| Provider Information | |||||||||
| NPI: | 1891979605 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DHAWAN | ||||||||
| FirstName: | SURINDER | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2669 | ||||||||
| Address2: | 1024 S. HORNER BLVD | ||||||||
| City: | SANFORD | ||||||||
| State: | NC | ||||||||
| PostalCode: | 273312669 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9197743680 | ||||||||
| FaxNumber: | 9197743682 | ||||||||
| Practice Location | |||||||||
| Address1: | 1024 S. HORNER BOULEVARD | ||||||||
| Address2: | |||||||||
| City: | SANFORD | ||||||||
| State: | NC | ||||||||
| PostalCode: | 273304151 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9197743680 | ||||||||
| FaxNumber: | 9197743682 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/28/2007 | ||||||||
| LastUpdateDate: | 02/12/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 9701318 | NC | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 89129CO | 05 | NC | MEDICAID |