Provider Demographics
NPI:1467448597
Name:SINGLA, SUDARSHAN KUMAR (MD)
Entity Type:Individual
Prefix:DR
First Name:SUDARSHAN
Middle Name:KUMAR
Last Name:SINGLA
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 1:13 S 7TH ST
Mailing Address - Street 2:POCONO LASER CENTER
Mailing Address - City:STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18360-2007
Mailing Address - Country:US
Mailing Address - Phone:570-424-8489
Mailing Address - Fax:
Practice Address - Street 1:13 S 7TH ST
Practice Address - Street 2:POCONO LASER CENTER
Practice Address - City:STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18360-2007
Practice Address - Country:US
Practice Address - Phone:570-424-8489
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-23
Last Update Date:2008-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD036553L2085R0202X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0010309710003Medicaid
PASIN612521OtherPENNSYLVANIA BLUE SHIELD
PAA64898Medicare UPIN
PA0010309710003Medicaid