Provider Demographics
NPI:1699944942
Name:I DHALIWAL MD PC
Entity type:Organization
Organization Name:I DHALIWAL MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:IQUBAL
Authorized Official - Middle Name:
Authorized Official - Last Name:DHALIWAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:508-384-1821
Mailing Address - Street 1:24 COMMON ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:WRENTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02093-1399
Mailing Address - Country:US
Mailing Address - Phone:508-384-1821
Mailing Address - Fax:508-384-0253
Practice Address - Street 1:24 COMMON ST
Practice Address - Street 2:SUITE 3
Practice Address - City:WRENTHAM
Practice Address - State:MA
Practice Address - Zip Code:02093-1399
Practice Address - Country:US
Practice Address - Phone:508-384-1821
Practice Address - Fax:508-384-0253
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-20
Last Update Date:2008-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA52229207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty