Provider Demographics
NPI:1588903918
Name:KRISHAN K SINGAL MD
Entity type:Organization
Organization Name:KRISHAN K SINGAL MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KRISHAN
Authorized Official - Middle Name:K
Authorized Official - Last Name:SINGAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-409-5647
Mailing Address - Street 1:415 CRAIN HWY S
Mailing Address - Street 2:
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061-3644
Mailing Address - Country:US
Mailing Address - Phone:410-766-5055
Mailing Address - Fax:410-768-7131
Practice Address - Street 1:415 CRAIN HWY S
Practice Address - Street 2:
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-3644
Practice Address - Country:US
Practice Address - Phone:410-766-5055
Practice Address - Fax:410-768-7131
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-05
Last Update Date:2013-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD63632207R00000X
MDR169414363LA2200X
MDD36900207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD446916000Medicaid