Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | DS042131 | PA |
Y | 213EG0000X | General Practice | DS042131 | PA |
NPI | 1003469685 |
---|---|
Provider Name | Anudeep Kaur Grewal |
First Address | Havertown, PA 19083-4630 |
Second Address | Havertown, PA 19083-4630 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/07/2019 |
Last Update Date | 12/12/2020 |