Provider Demographics
NPI:1356376958
Name:FAGOORA, PARAMJIT SINGH (MD)
Entity type:Individual
Prefix:
First Name:PARAMJIT
Middle Name:SINGH
Last Name:FAGOORA
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 1:5359 N FRESNO ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710-6831
Mailing Address - Country:US
Mailing Address - Phone:559-439-2040
Mailing Address - Fax:559-435-3918
Practice Address - Street 1:5359 N FRESNO ST
Practice Address - Street 2:SUITE 101
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-6831
Practice Address - Country:US
Practice Address - Phone:559-439-2040
Practice Address - Fax:559-435-3918
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2015-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA30486174400000X
CAA304860174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A304860Medicaid
CA0596740001Medicare NSC
BT594AMedicare PIN
BT593ZMedicare PIN
CAA26126Medicare UPIN
CA00A304860Medicaid