Provider Demographics
NPI:1659530921
Name:SINGH, SUPREET (MD)
Entity Type:Individual
Prefix:DR
First Name:SUPREET
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 1:11 LOLLER DR
Mailing Address - Street 2:
Mailing Address - City:MARTINSVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08836-2027
Mailing Address - Country:US
Mailing Address - Phone:201-315-5774
Mailing Address - Fax:330-572-3836
Practice Address - Street 1:11 LOLLER DR
Practice Address - Street 2:
Practice Address - City:MARTINSVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08836-2027
Practice Address - Country:US
Practice Address - Phone:201-315-5774
Practice Address - Fax:330-572-3836
Is Sole Proprietor?:No
Enumeration Date:2008-06-03
Last Update Date:2020-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.1297142085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0224748Medicaid