Provider Demographics
NPI:1184913865
Name:SAMRA, MANDEEP SINGH (MD)
Entity type:Individual
Prefix:
First Name:MANDEEP
Middle Name:SINGH
Last Name:SAMRA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:95 HIGHLAND AVE STE 309
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18017-9424
Mailing Address - Country:US
Mailing Address - Phone:484-245-1110
Mailing Address - Fax:484-403-7297
Practice Address - Street 1:1230 S CEDAR CREST BLVD
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18103-6367
Practice Address - Country:US
Practice Address - Phone:610-432-4529
Practice Address - Fax:610-432-2206
Is Sole Proprietor?:No
Enumeration Date:2011-04-01
Last Update Date:2022-06-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD459293207R00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA533659D8PMedicare PIN