Provider Demographics
NPI:1659807170
Name:PETER CHANG-SING, MD
Entity Type:Organization
Organization Name:PETER CHANG-SING, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:DG
Authorized Official - Last Name:CHANG-SING
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:707-573-7070
Mailing Address - Street 1:PO BOX 3368
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95402-3368
Mailing Address - Country:US
Mailing Address - Phone:707-573-7070
Mailing Address - Fax:707-573-7519
Practice Address - Street 1:500 DOYLE PARK DR
Practice Address - Street 2:SUITE 302
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95405-4558
Practice Address - Country:US
Practice Address - Phone:707-573-7070
Practice Address - Fax:707-573-7519
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-03
Last Update Date:2017-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG59460207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac ElectrophysiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE89772Medicare UPIN
CA00G594600Medicare PIN