Provider Demographics
NPI:1386678902
Name:CHANG SING, PETER D G (MD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:D G
Last Name:CHANG SING
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:PETER
Other - Middle Name:D G
Other - Last Name:CHANG SING
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:500 DOYLE PARK DR.
Mailing Address - Street 2:SUITE 302
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95405-4559
Mailing Address - Country:US
Mailing Address - Phone:707-573-7070
Mailing Address - Fax:707-573-7519
Practice Address - Street 1:500 DOYLE PARK DR
Practice Address - Street 2:SUITE 302
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95405-4558
Practice Address - Country:US
Practice Address - Phone:707-573-7070
Practice Address - Fax:707-573-7519
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG59460207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G594601Medicaid
CA00G594601Medicaid
CAE89772Medicare UPIN