Provider Demographics
NPI:1083636641
Name:SINGH, VINOD KUMAR (MD)
Entity Type:Individual
Prefix:
First Name:VINOD
Middle Name:KUMAR
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:PO BOX 26028
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87125-6028
Mailing Address - Country:US
Mailing Address - Phone:505-262-7174
Mailing Address - Fax:505-262-3562
Practice Address - Street 1:5400 GIBSON BLVD SE FL 2
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87108
Practice Address - Country:US
Practice Address - Phone:505-262-7174
Practice Address - Fax:505-262-3562
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2019-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV6695207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ173443Medicaid
MD22040Medicare ID - Type Unspecified
AZ173443Medicaid