Provider Demographics
NPI:1790701118
Name:FREMONT PSYCHIATRY MEDICAL GROUP, INC.
Entity Type:Organization
Organization Name:FREMONT PSYCHIATRY MEDICAL GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:BHUPINDER
Authorized Official - Middle Name:SINGH
Authorized Official - Last Name:WARAICH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:510-494-9313
Mailing Address - Street 1:722 MOWRY AVE
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94536-4115
Mailing Address - Country:US
Mailing Address - Phone:510-494-9313
Mailing Address - Fax:510-494-9991
Practice Address - Street 1:722 MOWRY AVE
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94536-4115
Practice Address - Country:US
Practice Address - Phone:510-494-9313
Practice Address - Fax:510-494-9991
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA539682084P0800X
CAG679042084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G679041Medicare ID - Type Unspecified
CA00G539680Medicare ID - Type Unspecified
CAF52144Medicare UPIN
CAG64437Medicare UPIN