Provider Demographics
NPI:1114132131
Name:PREETENDER SANDHU MD
Entity type:Organization
Organization Name:PREETENDER SANDHU MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MGR
Authorized Official - Prefix:
Authorized Official - First Name:LOUISE
Authorized Official - Middle Name:
Authorized Official - Last Name:MACY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-298-8223
Mailing Address - Street 1:4957 ELLIS LN
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21043-6852
Mailing Address - Country:US
Mailing Address - Phone:410-747-0360
Mailing Address - Fax:410-298-8225
Practice Address - Street 1:1940 W BALTIMORE ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21223-2245
Practice Address - Country:US
Practice Address - Phone:410-362-4481
Practice Address - Fax:410-298-8225
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0057543207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty