Provider Demographics
NPI:1780784389
Name:SINGH, GURSHARAN (MD)
Entity type:Individual
Prefix:DR
First Name:GURSHARAN
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 1:323 E CENTER ST
Mailing Address - Street 2:
Mailing Address - City:MAHANOY CITY
Mailing Address - State:PA
Mailing Address - Zip Code:17948
Mailing Address - Country:US
Mailing Address - Phone:570-773-2301
Mailing Address - Fax:570-773-1105
Practice Address - Street 1:323 E CENTER ST
Practice Address - Street 2:
Practice Address - City:MAHANOY CITY
Practice Address - State:PA
Practice Address - Zip Code:17948
Practice Address - Country:US
Practice Address - Phone:570-773-2301
Practice Address - Fax:570-773-1105
Is Sole Proprietor?:No
Enumeration Date:2006-09-24
Last Update Date:2016-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD030815E208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000951036Medicaid
D70010Medicare UPIN
PASI49621Medicare ID - Type Unspecified