Provider Demographics
NPI:1629040027
Name:MAC, SURENDRAPAL SIHGH (MD)
Entity Type:Individual
Prefix:MR
First Name:SURENDRAPAL
Middle Name:SIHGH
Last Name:MAC
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:PO BOX 1230
Mailing Address - Street 2:
Mailing Address - City:ALBEMARLE
Mailing Address - State:NC
Mailing Address - Zip Code:28002
Mailing Address - Country:US
Mailing Address - Phone:704-983-3314
Mailing Address - Fax:
Practice Address - Street 1:816 N 3RD STREET
Practice Address - Street 2:
Practice Address - City:ALBEMARLE
Practice Address - State:NC
Practice Address - Zip Code:28001
Practice Address - Country:US
Practice Address - Phone:704-983-3314
Practice Address - Fax:704-983-3315
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC23303207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
53638OtherBCBS
NC8953638Medicaid
208403Medicare ID - Type Unspecified
C85258Medicare UPIN