Provider Demographics
NPI:1902913569
Name:RANDHAWA, SANJEEVAN (MD)
Entity Type:Individual
Prefix:
First Name:SANJEEVAN
Middle Name:
Last Name:RANDHAWA
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 1:280 CHESTNUT ST
Mailing Address - Street 2:2ND FL
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01199-1001
Mailing Address - Country:US
Mailing Address - Phone:413-794-5700
Mailing Address - Fax:
Practice Address - Street 1:46 DAGGETT DRIVE
Practice Address - Street 2:
Practice Address - City:W. SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01089-4638
Practice Address - Country:US
Practice Address - Phone:413-794-9110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2018-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA230208207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine