Provider Demographics
NPI:1316621493
Name:ELK GROVE DERMATOLOGY
Entity type:Organization
Organization Name:ELK GROVE DERMATOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JASPREET
Authorized Official - Middle Name:SINGH
Authorized Official - Last Name:NANRA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:510-789-3094
Mailing Address - Street 1:3150 G ST STE E
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95340-1346
Mailing Address - Country:US
Mailing Address - Phone:510-789-3094
Mailing Address - Fax:
Practice Address - Street 1:3150 G ST STE E
Practice Address - Street 2:
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95340-1346
Practice Address - Country:US
Practice Address - Phone:510-789-3094
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-09
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural DermatologyGroup - Multi-Specialty