Provider Demographics
NPI:1629173620
Name:SINGH, INDRA P (MD)
Entity Type:Individual
Prefix:
First Name:INDRA
Middle Name:P
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 1:2425 BISSO LN
Mailing Address - Street 2:#100
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94520-4897
Mailing Address - Country:US
Mailing Address - Phone:925-521-5620
Mailing Address - Fax:925-521-5639
Practice Address - Street 1:2425 BISSO LN
Practice Address - Street 2:#100
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94520-4897
Practice Address - Country:US
Practice Address - Phone:925-521-5620
Practice Address - Fax:925-521-5639
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2014-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2386922084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00189368Medicare ID - Type UnspecifiedRAILROAD MEDICARE
NYRA4560Medicare ID - Type UnspecifiedUPSTATE MEDICARE
I17590Medicare UPIN
RA4559Medicare ID - Type UnspecifiedUPSTATE MEDICARE