Provider Demographics
NPI:1679532279
Name:SANDHU, MAHESH S (DO)
Entity type:Individual
Prefix:
First Name:MAHESH
Middle Name:S
Last Name:SANDHU
Suffix:
Gender:M
Credentials:DO
Other - Prefix:DR
Other - First Name:MAHESH
Other - Middle Name:S
Other - Last Name:SANDHU
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:3402 BATTLEGROUND AVE
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27410-2404
Mailing Address - Country:US
Mailing Address - Phone:336-545-1515
Mailing Address - Fax:336-545-4505
Practice Address - Street 1:3402 BATTLEGROUND AVE
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27410-2404
Practice Address - Country:US
Practice Address - Phone:336-545-1515
Practice Address - Fax:336-545-4505
Is Sole Proprietor?:No
Enumeration Date:2006-03-22
Last Update Date:2024-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.007331207P00000X
PAOS 008390L207P00000X
CACA 20A6744207P00000X
NC2014-00296207P00000X, 207Q00000X, 2081S0010X
OH340073312081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1679532279OtherNC MEDICAL BOARD 2014-00296