Provider Demographics
NPI:1003871351
Name:SINGH, GURDIAL N (MD)
Entity Type:Individual
Prefix:
First Name:GURDIAL
Middle Name:N
Last Name:SINGH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:239 W COMMERCE ST
Mailing Address - Street 2:
Mailing Address - City:SHAMOKIN
Mailing Address - State:PA
Mailing Address - Zip Code:17872-5357
Mailing Address - Country:US
Mailing Address - Phone:570-648-1166
Mailing Address - Fax:570-648-1360
Practice Address - Street 1:239 W COMMERCE ST
Practice Address - Street 2:
Practice Address - City:SHAMOKIN
Practice Address - State:PA
Practice Address - Zip Code:17872-5357
Practice Address - Country:US
Practice Address - Phone:570-648-1166
Practice Address - Fax:570-648-1360
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2012-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD038257L2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0005712330005Medicaid
PAD68768Medicare UPIN
SI99163Medicare PIN
SI099163Medicare PIN