Provider Demographics
NPI:1053419192
Name:DHILLON, PERMINDER (MD)
Entity type:Individual
Prefix:DR
First Name:PERMINDER
Middle Name:
Last Name:DHILLON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1410 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:NEEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02492-2671
Mailing Address - Country:US
Mailing Address - Phone:781-444-5846
Mailing Address - Fax:781-449-1159
Practice Address - Street 1:1410 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:NEEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02492-2671
Practice Address - Country:US
Practice Address - Phone:781-444-5846
Practice Address - Fax:781-449-1159
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2008-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA54684207RC0000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3033228Medicaid
MAA59208Medicare UPIN
MAJ06867Medicare PIN