Provider Demographics
NPI:1184668089
Name:SINGH, RANDEEP (MD)
Entity Type:Individual
Prefix:
First Name:RANDEEP
Middle Name:
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 1:400 N MCDOWELL BLVD
Mailing Address - Street 2:(PETALUMA VALLEY HOSPITAL)
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94954-2339
Mailing Address - Country:US
Mailing Address - Phone:707-778-2674
Mailing Address - Fax:707-773-1519
Practice Address - Street 1:1001 POTRERO AVENUE
Practice Address - Street 2:RM 1E21
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110-3518
Practice Address - Country:US
Practice Address - Phone:415-206-5753
Practice Address - Fax:415-206-5818
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2009-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA78788207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A787880Medicaid
CA930119012OtherRAILROAD MEDICARE
H44489Medicare UPIN
CA00A787880Medicaid
CA00A787883Medicare PIN