Provider Demographics
NPI:1609861475
Name:SINGH, MADHU (PAC)
Entity Type:Individual
Prefix:
First Name:MADHU
Middle Name:
Last Name:SINGH
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19415 DEERFIELD AVENUE
Mailing Address - Street 2:SUITE 112
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20176
Mailing Address - Country:US
Mailing Address - Phone:703-724-1195
Mailing Address - Fax:703-724-4495
Practice Address - Street 1:19415 DEERFIELD AVENUE
Practice Address - Street 2:SUITE 112
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176
Practice Address - Country:US
Practice Address - Phone:703-724-1195
Practice Address - Fax:703-724-4495
Is Sole Proprietor?:No
Enumeration Date:2005-09-16
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110002010363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC06319OtherMEDICARE GROUP PIN
DCG00426OtherMEDICARE GROUP PIN
DC020809L26Medicare PIN
DCG00426OtherMEDICARE GROUP PIN
VAC06319OtherMEDICARE GROUP PIN