Provider Demographics
NPI:1831207232
Name:SINGH, PREM D (MD)
Entity type:Individual
Prefix:
First Name:PREM
Middle Name:D
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 1:2210 E ILLINOIS AVE STE 206
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93701-2184
Mailing Address - Country:US
Mailing Address - Phone:559-264-2504
Mailing Address - Fax:559-264-3707
Practice Address - Street 1:2210 E ILLINOIS AVE STE 206
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93701-2184
Practice Address - Country:US
Practice Address - Phone:559-264-2504
Practice Address - Fax:559-264-3707
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-26
Last Update Date:2015-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA36220208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A362200Medicaid
CAGR0069900Medicaid
A28005Medicare UPIN