Provider Demographics
NPI:1982687778
Name:SINGH, MAGAN (MD)
Entity Type:Individual
Prefix:
First Name:MAGAN
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 1:3998 FAIR RIDGE DRIVE - SUITE 300
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22033
Mailing Address - Country:US
Mailing Address - Phone:703-295-9360
Mailing Address - Fax:703-766-9725
Practice Address - Street 1:25 CHURCH ST
Practice Address - Street 2:
Practice Address - City:WILKES BARRE
Practice Address - State:PA
Practice Address - Zip Code:18765-0999
Practice Address - Country:US
Practice Address - Phone:570-346-7797
Practice Address - Fax:570-342-9802
Is Sole Proprietor?:No
Enumeration Date:2005-11-25
Last Update Date:2015-04-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD052217L207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1479141Medicaid
050083806OtherRR MEDICARE
F81440Medicare UPIN
PA005800Medicare PIN
PA005800F4NMedicare PIN