Provider Demographics
NPI:1346536711
Name:DOSANJH, BALTEJ SINGH (MD)
Entity Type:Individual
Prefix:
First Name:BALTEJ
Middle Name:SINGH
Last Name:DOSANJH
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 1:1401 SPANOS CT STE 205
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95355-2813
Mailing Address - Country:US
Mailing Address - Phone:209-525-3199
Mailing Address - Fax:209-525-3802
Practice Address - Street 1:1401 SPANOS CT STE 205
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95355-2813
Practice Address - Country:US
Practice Address - Phone:209-525-3199
Practice Address - Fax:209-525-3802
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-23
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA127059207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine