Provider Demographics
NPI:1619040342
Name:SINGLETON-BEN, MIA A (MD)
Entity Type:Individual
Prefix:
First Name:MIA
Middle Name:A
Last Name:SINGLETON-BEN
Suffix:
Gender:F
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:PO BOX 2147
Mailing Address - Street 2:
Mailing Address - City:OPELOUSAS
Mailing Address - State:LA
Mailing Address - Zip Code:70571-2147
Mailing Address - Country:US
Mailing Address - Phone:337-407-8697
Mailing Address - Fax:337-407-9096
Practice Address - Street 1:920 N. MAIN ST.
Practice Address - Street 2:
Practice Address - City:OPELOUSAS
Practice Address - State:LA
Practice Address - Zip Code:70570
Practice Address - Country:US
Practice Address - Phone:337-407-8697
Practice Address - Fax:337-407-9096
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2011-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA022773174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1449482Medicaid
LA721467200OtherTAX ID #
LAG81914Medicare UPIN