Provider Demographics
NPI:1033113436
Name:SINGH, POONAM (MD)
Entity Type:Individual
Prefix:DR
First Name:POONAM
Middle Name:
Last Name:SINGH
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 1:455 SCHOOL ST
Mailing Address - Street 2:STE 26
Mailing Address - City:TOMBALL
Mailing Address - State:TX
Mailing Address - Zip Code:77375-4597
Mailing Address - Country:US
Mailing Address - Phone:281-374-9700
Mailing Address - Fax:281-370-8765
Practice Address - Street 1:455 SCHOOL ST
Practice Address - Street 2:STE 26
Practice Address - City:TOMBALL
Practice Address - State:TX
Practice Address - Zip Code:77375-4597
Practice Address - Country:US
Practice Address - Phone:281-374-9700
Practice Address - Fax:281-370-8765
Is Sole Proprietor?:No
Enumeration Date:2005-06-13
Last Update Date:2015-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ1399208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX5810519OtherAETNA
TXF74696Medicare UPIN
TX760530251OtherTAX ID
TX121269801Medicaid
TX8J3415OtherBLUE CROSS & BLUE SHIELD
TXJ1399OtherMEDICAL LICENSE
TX8A7518Medicare ID - Type Unspecified