Provider Demographics
NPI:1336244904
Name:SRAN, MANJINDER SINGH (MD)
Entity Type:Individual
Prefix:
First Name:MANJINDER
Middle Name:SINGH
Last Name:SRAN
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 1:10470 OLD PLACERVILLE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95827-2539
Mailing Address - Country:US
Mailing Address - Phone:800-470-0071
Mailing Address - Fax:
Practice Address - Street 1:2000 SUTTER PL
Practice Address - Street 2:
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95616-6201
Practice Address - Country:US
Practice Address - Phone:530-750-5226
Practice Address - Fax:530-750-5228
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2018-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD64675207R00000X
NC2006-01515207R00000X
CAC54556207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCP00366618OtherRR MEDICAID
NC5905307Medicaid
NC2335816OtherMEDICARE PTAN, C.HOSP GRP-WILKES
NC2335816OtherMEDICARE PTAN, C.HOSP GRP-WILKES
NC165199Medicare UPIN