Provider Demographics
NPI:1508097452
Name:SINGH, BALRAJ (MD)
Entity Type:Individual
Prefix:DR
First Name:BALRAJ
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 1:521 W STATE ROAD 434 STE 307&308
Mailing Address - Street 2:
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32750-4984
Mailing Address - Country:US
Mailing Address - Phone:321-841-6444
Mailing Address - Fax:321-842-1955
Practice Address - Street 1:521 W STATE ROAD 434 STE 307&308
Practice Address - Street 2:
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32750-4984
Practice Address - Country:US
Practice Address - Phone:321-841-6444
Practice Address - Fax:321-842-1955
Is Sole Proprietor?:No
Enumeration Date:2009-07-27
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME129943207RC0000X
TN49135207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL018929400Medicaid
KY7100263580Medicaid
VA1508097452Medicaid
NC1508097452Medicaid
TN1530760Medicaid