Provider Demographics
NPI:1093852659
Name:PREM D. SINGH, M.D. & ASSOC
Entity Type:Organization
Organization Name:PREM D. SINGH, M.D. & ASSOC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PREM
Authorized Official - Middle Name:DEEP
Authorized Official - Last Name:SINGH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:559-264-2504
Mailing Address - Street 1:2210 E. ILLINOIS
Mailing Address - Street 2:SUITE 206
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93701-2166
Mailing Address - Country:US
Mailing Address - Phone:559-264-2504
Mailing Address - Fax:559-264-3707
Practice Address - Street 1:2210 E ILLINOIS AVE
Practice Address - Street 2:SUITE 206
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93701-2125
Practice Address - Country:US
Practice Address - Phone:559-264-2504
Practice Address - Fax:559-264-3707
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2015-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0069900Medicaid